Table 6 Final recommendations to improve identification of people with osteoporotic vertebral fractures identified using the Nominal Group Technique
Patient appraisal, self-management and decision to consult healthcare professional | |
|---|---|
Recommendation | Key group |
1. Information for patients about what vertebral fractures are and the symptoms, such as such as severe pain that doesn’t improve with time and curvature of the spine. | Patients |
2. Information for patients about the risk factors for vertebral fractures, such as the menopause and steroids. | Patients |
3. Encourage patients to consult their GP if they have symptoms that suggest they may had had a vertebral fracture, particularly (although not always) after a fall or injury. | Patients |
Healthcare professional appraisal, investigations, referrals and appointments | |
4. Guidance for healthcare professionals in primary care about the risk factors for vertebral fractures when patients present with back pain, such as menopause and steroids. | Healthcare professionals |
5. Guidance for healthcare professionals that people who do not have symptoms may have vertebral fractures. Information that other groups that are not ‘typical’ osteoporotic patients such as younger women and men may also be at risk. | Healthcare professionals |
6. Guidance for healthcare professionals in primary care about the symptoms of vertebral fractures, such as severe pain that doesn’t improve with time and curvature of the spine. | Healthcare professionals |
7. Guidance for GPs on how to carry out a full and comprehensive assessment for vertebral fractures, including physical examination. | Healthcare professionals |
8. An evidence-based tool for healthcare professionals in primary or secondary care, outlining who needs to be referred for imaging for vertebral fractures. | Healthcare professionals |
9. Guidance for healthcare professionals about referral pathways for vertebral fractures, such as how to refer for imaging and who is responsible for prescribing bone protection therapies. | Healthcare professionals |
Communication of diagnosis | |
10. Communicate the diagnosis to patients verbally (face to face if possible) followed by a patient-friendly letter. Explain to patients what vertebral fractures are, how they are treated, and the implications of having a vertebral fracture. | Healthcare professionals |
11. Use clear and consistent terminology to describe vertebral fractures. | Healthcare professionals |
12. Direct patients to patient-friendly information about vertebral fractures and make these available in GP surgeries. | Healthcare professionals |
Planning and scheduling of treatment | |
13. Information for patients about the risks of having further fractures, the importance of bone health and bone protection therapies. | Patients |
14. Encourage patients to ask healthcare professionals about bone protection therapies if they are not offered. If they have fractured while on bone protection therapies, encourage patients to ask for a review of their medication. | Patients |
9. Guidance for healthcare professionals about referral pathways for vertebral fractures, such as how to refer for imaging and who is responsible for prescribing bone protection therapies (Recommendation as above) | Healthcare professionals |