Improving practices in orthogeriatric care services: a multi-method study

Improving practices in orthogeriatric care services: a multi-method study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improving practices in orthogeriatric care services: a multi-method study Fabien VISADE, Simon Havet, Pierre Robinet, François Maladry, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3744450/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Orthogeriatric units have proven to be relevant in the care of older patients. A combination of hospital and community care is recommended for optimized care when these older patients return home. However, general practitioners (GPs) have not provided any feedback on this. The aim of this study was to look at GPs’ opinions on the care provided in orthogeriatric units to identify areas for improvement. Methods Multi-method study combining one phase comprised of a retrospective analysis of data on older patients hospitalized in an orthogeriatric unit, and another phase analyzing GPs’ answers to a questionnaire. By comparing the results of the two analysis phases we were able to identify areas for improvement. Results 355 hospital stays were analyzed. The mean age of the older patients was 87 years (SD = 5.8), and patients were predominantly women (n = 292, 82%). The most common surgery performed was femur surgery (n = 240, 68%). Patients suffered from undernutrition (n = 226, 64%), a vitamin D deficiency (n = 247, 70%) and chronic falls (n = 55, 16%). The questionnaire was completed by 51 GPs. Comparing the results of the retrospective analysis and questionnaire identified two areas for improvement: (i) helping patients receive osteoporosis care; (ii) involving occupational therapists more during the orthogeriatric unit stay. Conclusion Improvements in practices are always needed, especially when caring for older patients. In orthogeriatric units, this care must involve occupational therapists more and improve screening and treatment for osteoporosis. Figures Figure 1 Key summary points Aim to explore general practitioners’ expectations regarding the care of older patients hospitalized in an orthogeriatric unit to highlight possible areas for improvement. Findings highlighted two areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients’ care. Message These areas for improvement will help to optimize care pathways for older adults by coordinating care more efficiently between hospital services and home care providers. Introduction Orthogeriatric units offer coordinated care for fracture traumas in older adults, provided by a range of healthcare providers including orthopaedic surgeons and geriatricians [ 1 – 5 ]. The most common problem treated in orthogeriatric units is proximal femoral fracture caused by a fall [ 6 – 8 ]. The many benefits with this type of care include lower mortality rates and preventing loss of functional autonomy [ 9 , 10 ], confusional state and falls [ 11 , 12 ]. Many hospitals now have orthogeriatric units that are integrated into the care pathway for older patients with fracture traumas. When the patient is discharged, the general practitioner plays a key part in the surgery recovery process, for example by ensuring that the patient is able to stay at home or by following up on specialist consultations. In addition, the combination of interventions and the involvement of hospital and community practitioners gives better results, such as improving the recovery of physical functions and nutritional status [ 13 , 14 ]. It is therefore important to know whether the care provided in orthogeriatric units is satisfactory to general practitioners. No feedback has been provided to date, and it is important to know the opinions of primary care providers to be able to improve our practices and the care of older patients staying in orthogeriatric units. In this study, we aimed to explore general practitioners’ expectations regarding the care of older patients hospitalized in an orthogeriatric unit to highlight possible areas for improvement. Method Study design We conducted a multi-method study. This type of research was used to precisely identify areas for improvement. Using a questionnaire-based study, we analyzed general practitioners’ expectations regarding the care of patients hospitalized in an orthogeriatric unit. Using a quantitative study, we analyzed orthogeriatric unit data available from the Lille Catholic Institute Hospital Group (GHICL). This made it possible to quantify what was offered to patients during their stay in the orthogeriatric unit. The two studies provided different but complementary results. The results of the questionnaire and quantitative study were compared and discussed to meet the main objective. The study design is available in Fig. 1 . Ethics Consent for the proposed research was given on 14 December 2022 by the GHICL Internal Research Ethics Committee - IRB 00013355. The latter validated the regulatory and ethical compliance of the research. The data collected is appropriate and relevant, and limited to what is necessary for the purposes described. The data was collected and stored securely. SPHINX software (Python Documentation Generator) was used for the questionnaire, guaranteeing the participants’ anonymity. Questionnaire-based study The study population All general practitioners and junior doctors practising general medicine in the Nord department of the Hauts-de-France region in France were able to participate. They were invited to take part via a letter explaining the study and what the orthogeriatric unit is. This letter was sent by email, to the Facebook group and by post with orthogeriatric unit hospitalization reports. A QR code was also sent providing a link to directly access the questionnaire. A note explaining what the orthogeriatric unit is was provided with the questionnaire. Data collection The questionnaire had open and closed-ended questions for participants to express themselves freely. It was created by the research team who reached a consensus on the items to include. There were two versions of the questionnaire, one for GPs and another for junior doctors practising general medicine. The GP questionnaire included 14 items divided into two parts with seven items each. The first part concerned GPs’ expectations of care in an orthogeriatric unit: to facilitate post-trauma physiotherapy; reduce the risk of institutionalization; help them receive osteoporosis care; help them receive geriatric care; facilitate direct admissions for repeat hospitalizations; reduce the risk of mortality; improve the psychological well-being of patients after a fracture. The second part concerned recommendations for improving orthogeriatric unit activities: early social and family environment assessments; early assessment of equipment in the place of residence; improving communication with GPs; improving communication with home nurses; improving communication with occupational therapists; improving communication with the family before discharge. Both parts of the questionnaire ended with a free open-ended item. The questionnaire for junior doctors practising general medicine asked whether they had ever worked in an orthogeriatric unit. If so, they could talk freely about their experience. If not, they were asked whether they thought it would be useful for their future practice to spend part of their training in an orthogeriatric unit. The questionnaire was hosted on the Sphinx online software. Participants could answer the questionnaire from 24 January to 31 March 2023 included. Data analysis The answers to all of the questions were qualitative. Numbers and frequencies were calculated for each question. R software was used to perform these analyses. The answers to open-ended questions were analyzed by the research team. The quantitative study The study population Data was collected from patients at least 75 years old hospitalized in an orthogeriatric unit between April 2021 and June 2022. Eligible patients were identified by the Medical Information Department. Data extraction The extracted data was coded according to the international classification of diseases (ICD-10). It was transcribed as medical data by the principal investigators (SH and FV) according to current recommendations [ 15 ]. The patients’ quantitative and qualitative variables were collected: sociodemographic criteria, care pathway, surgical procedures, medical diagnoses and the care providers working in the perioperative orthogeriatric unit. Data analysis The statistical unit was the patient’s stay in the orthogeriatric unit. A stay was defined as a patient’s admission to the orthogeriatric unit. First of all, a descriptive analysis of the quantitative and qualitative data was carried out. Categorical variables were expressed as a frequency (percentage). Continuous variables were expressed as the mean ± standard deviation in case of a normal distribution or as the median [interquartile range]. Normal data distributions were verified graphically and by applying the Shapiro-Wilk test. All analyses were performed using R software (version 3.4.3) [ 16 ]. Comparison of the two studies’ results The purpose of this step was to combine the results of the questionnaire and quantitative study to reach a conclusion in line with the main objective. To do this, the researchers (SH and FV) compared each questionnaire answer to the data extracted from the quantitative study. This was to find out whether any of the GPs’ expectations or recommendations mentioned in the questionnaire answers matched data in the orthogeriatric unit database. If they did, they were not considered an area for improvement because the orthogeriatric unit was already aware of this expectation. If there was no match, we considered this a possible area for improvement. Results Results of the questionnaire-based study Population A total 51 GPs answered the questionnaire, including 20 junior doctors practising general medicine. The majority of GPs were women (n = 16, 51.6%), mostly between 30 and 40 years old (n = 13, 41.9%), tending to work in a semi-rural location (n = 21, 67.7%). Their characteristics are summarized in Table 1 . The junior doctors practising general medicine included more women than men (n = 12, 60%), and most were under 30 years old (n = 18, 90%). Table 1 Characteristics of general practitioners answering the study questionnaire N=31 Gender (female) N (%) 16 (51.6) Age (years) N (%) 60 30 – 40 41 – 50 51 – 60 10 (32.3) 2 (6.5) 13 (41.9) 2 (6.5) 4 (12.9) Type of practice N (%) Rural Semi-rural Urban 1 (3.2) 21 (67.7) 9 (29) Years of practice N (%) 20 11 – 20 2 – 5 6 – 10 13 (41.9) 6 (19.4) 3 (9.7) 4 (12.9) 5 (16.1) Academic gerontology training ( yes) N (%) 2 (6.5) Estimated percentage for each patient age group Median [Q1-Q3] 0 – 18 years 18 – 30 30 – 65 >65 >75 polypathological Elderly nursing home 20 [15; 30] 15 [15; 22.5] 30 [20; 32] 20 [10; 27.5] 10 [4.5; 14.5] 1 [0; 5] [Q1 – Q3]: interquartile range Answers to the questionnaire All 31 GPs answering the questionnaire expected the perioperative orthogeriatric unit to reduce the risk of their patients being institutionalized. The vast majority (30 (96.8%)) of GPs expected the orthogeriatric unit stay to facilitate physical therapy after trauma surgery. Around half (17 (55%)) expected the orthogeriatric unit to help their patients receive osteoporosis care. Thirty (96.8%) GPs advised improving communication with primary care providers. Twenty (64.5%) GPs felt that communication with occupational therapists needed to be improved. Nineteen junior doctors practising general medicine had never worked in an orthogeriatric unit, and 8 (42%) believed that spending part of their training in an orthogeriatric unit would be useful for their future practice. The details of the answers are shown in Table 2 . Table 2 Answers to the study questionnaire Items N = 31 Expectations of GPs Facilitate physiotherapy after trauma surgery (yes) N (%) 30 (96.8) Reduce the risk of institutionalization (yes) N (%) 31 (100) Help patients receive osteoporosis care (yes) N (%) 17 (55) Help patients receive geriatric care (yes) N (%) 27 (87) Facilitate repeat hospitalization (direct admission if necessary) (yes) N (%) 27 (87) Reduce the risk of mortality (yes) N (%) 30 (96.8) Improve the psychological well-being of patients after their fracture episode (yes) N (%) 29 (93.5) GP recommendations Early social and family environment assessment (yes) N (%) 30 (96.8) Early assessment of equipment in the place of residence (yes) N (%) 30 (96.8) Improve communication with general practitioners (yes) N (%) 30 (96.8) Improve communication with nurses (yes) N (%) 30 (96.8) Improve communication with physiotherapists (yes) N (%) 30 (96.8) Improve communication with occupational therapists (yes) N (%) 20 (64.5) Improve communication with the family before discharge (yes) N (%) 30 (96.8) The analysis of the verbatim comments highlighted one priority in particular: the liaison between community care and hospital care, which GPs stressed is important for better patient care: “ coordinated care of older polypathological patients” (1 GP) “ teamwork for communicating and coordinating with orthopaedic surgeons and anaesthetists” (1 GP) “to help them return home: incorporate the GP into their care pathway” (1 GP) Results of the quantitative study Between April 2021 and June 2022, 355 stays including a single admission to the orthogeriatric unit were analyzed. The mean age of patients admitted to the orthogeriatric unit was 87 years (standard deviation ± 5.8). The majority of patients were women (n = 292, 82%). For most stays, patients came from their home (n = 291, 82%). Most of the surgical procedure codes were for a hip joint replacement and femoral osteosynthesis. Most of the medical diagnosis codes were for undernutrition (n = 226, 64%) and vitamin D deficiency (n = 247, 70%). Only 13 stays (4%) were coded for osteoporosis. The main care providers working in the orthogeriatric unit were physiotherapists (n = 281, 79%), social workers (n = 189, 53%) and dieticians (n = 138, 39%). Details of the results of the quantitative analysis are shown in Table 3 . Table 3 Results of the quantitative analysis of the extracted data coded according to the international classification of diseases (ICD-10) N = 355 Age (years), mean (SD) 87 (5.8) Gender (female), N (%) 292 (82.3) Place of residence, N (%) Own home Elderly nursing home Retirement home 291 (82) 37 (10.4) 24 (6.8) Recent hospitalization (< 6 months) (yes), N (%) 278 (78.3) Reason for discharge from perioperative orthogeriatric unit, N (%) Death Return home Other short-term hospital care unit Follow-up care and rehabilitation facility 7 (2) 133 (37.5) 31 (8.7) 184 (51.8) Length of hospital stay (days), mean (SD) 11.8 (6.2) Length of stay in perioperative orthogeriatric unit (days), mean (SD) 9.3 (5.4) Time to admission to perioperative orthogeriatric unit (days), mean (SD) 2.1 (2.5) Undernutrition*, N (%) 226 (64) Vitamin D deficiency, N (%) 247 (70) Major neurocognitive disorders, N (%) 92 (26) Repeat falls**, N (%) 55 (16) Osteoporosis, N (%) 13 (4) Bed sores, N (%) Stage 1 Stage 2 Stage 3 Stage 4 47 (13) 34 (10) 10 (3) 2 (0.6) Infections with antibiotics prescribed, N (%) 141 (40) Anaemia requiring transfusion, N (%) 53 (15) Femoral fracture, N (%) 283 (80) Cervical spine fracture, N (%) 4 (1.1) Thoracic spine and/or rib fracture, N (%) 5 (1.4) Lumbar spine and/or pelvic fracture, N (%) 38 (11) Shoulder and/or arm fracture, N (%) 37 (10) Wrist and/or hand fracture, N (%) 7 (2) Leg and/or ankle fracture, N (%) 21 (6) Hip joint replacement surgery, N (%) 120 (34) Femoral osteosynthesis surgery, N (%) 120 (34) Osteosynthesis surgery on the forearm bone, N (%) 10 (2.8) Osteosynthesis surgery on the humerus, N (%) 4 (1.12) Other***, N (%) 101 (28) Care providers working in the perioperative orthogeriatric unit, N (%) Doctor Foundation doctor Physiotherapist Social worker Dietitian Speech therapist Psychologist Pharmacist Pedicurist-podiatrist 353 (99.4) 319 (90) 281 (79) 189 (53) 138 (39) 36 (10) 15 (4) 6 (1.7) 2 (0.5) SD: Standard deviation * Loss of 5% of weight in one month, or 10% of weight in 6 months ** >2 falls in one year *** Either orthopaedic treatment or other type of surgery not sought in the analyses (ankle for example) Comparison of the two studies’ results Some GPs’ answers to the questionnaire recommended activities already offered in the orthogeriatric unit. For example, the data from the quantitative study confirmed that staying in a perioperative orthogeriatric unit facilitated physical therapy after trauma surgery, since more than half of the stays (n = 184, 51.8%) resulted in discharge to a follow-up care and rehabilitation facility. Similarly, when GPs recommended an early assessment of equipment in the place of residence, the data from the quantitative study confirmed that there was a social worker visit for more than half of the stays (n = 189, 53%). The GPs had diverging opinions over certain questionnaire items, two of which can be considered possible areas for improvement for orthogeriatric units. Not all GPs agreed that the orthogeriatric unit helps patients to receive osteoporosis care (17 GPs (55%)), or that it was important to facilitate communication with occupational therapists (20 GPs (64.5%)). This was consistent with the data from the quantitative study, as only 13 stays (4%) were coded with an osteoporosis diagnosis, and there was no occupational therapist code during the stay. Discussion This study sought to analyze GPs’ expectations regarding the care of older patients hospitalized in orthogeriatric units and identify areas for improvement. All GPs expected a stay in the orthogeriatric unit to facilitate physical therapy, reduce the risk of institutionalization, and reduce mortality. The majority of GPs agreed that the liaison between hospital care and primary care should remain a priority of patient care in orthogeriatric units. Lastly, comparing the results of the questionnaire and quantitative study highlighted two areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients’ care. We are not the first to highlight the lack of osteoporosis screening in orthogeriatric units. In a meta-analysis in 2020, Van Camp et al. showed that the care provided in orthogeriatric units was rarely associated with more osteoporosis diagnoses or the introduction of calcium and vitamin D supplements and osteoporosis medications [ 17 ]. In the general population there is also a discrepancy between the number of older adults treated for osteoporosis and the proportion of people considered eligible for treatment according to their fracture risk [ 18 ]. Based on the conservative assumption that treatments are only given to high-risk patients, international and European prescribing data suggests that more than 57% of high-risk women do not receive any treatment specifically for their bones [ 19 ]. Osteoporosis is a public health problem due to its frequency and population ageing. In orthogeriatric units, the majority of patients have osteoporosis, which is logical as in most cases they are older patients with fractures resulting from low-energy falls [ 20 ]. Our study confirms, once again, that osteoporosis screening must be improved for older patients, especially in orthogeriatric units. GPs are also on the front line, as they are responsible for the patients’ long-term follow-up. Orthogeriatric units could offer automatic screening and care procedures to improve the screening and monitoring of osteoporosis patients. If these procedures are already in place, this practice should be evaluated. One solution could be to automatically implement treatment during an orthogeriatric unit stay and, if this is not possible, always liaise with GPs to ensure the treatment is implemented at home. A study by Harwood et al. in 2004 proved that giving vitamin D supplements to women staying at an orthogeriatric unit for a proximal femoral fracture reduced the risk of falls in the following year [ 21 ]. In that study, 70% of patients had a vitamin D deficiency, consistent with the characteristics of our study’s patients (70% of stays), confirming the need to take effective measures to prevent diseases linked to fragile bones. We are not the first to highlight that improving communication with occupational therapists in perioperative orthogeriatric units is another possible area for improvement. In a study in 2023, Jasper et al. showed that the sedentary lifestyle of older patients, particularly in orthogeriatric units, was a real problem limiting early physical therapy, and that one possible solution was to involve occupational therapists in their care [ 22 ]. Indeed, occupational therapists play a key role in the care of older patients in orthogeriatric units. They improve and speed up rehabilitation for patients losing their autonomy [ 23 ], and patients who have just had surgery after a fracture. The way occupational therapists are involved in these patients’ care, whether in hospital or at home, must also be reviewed. Training healthcare providers such as occupational therapists from the start of their careers would help them to understand the particularities of care for older patients. This is an interesting idea that has already been suggested [ 24 ]. Another solution would be to involve occupational therapists after patients are discharged from the orthogeriatric unit. This goes without saying for patients being discharged to a follow-up care and rehabilitation facility, but does not necessarily happen when patients return home or to a nursing home (which is the case for 37.5% of the stays in our study). Involving the GP to ensure that patients discharged home benefit from occupational therapy is therefore an aspect of care that can be improved. The quantitative study databases were of high quality. The characteristics of patients treated in the orthogeriatric unit in our study were generally similar to what is described in one of the most cited orthogeriatric studies, which adds external validation to our results (7). What was innovative about our research was that it was able to converge the results of the two complementary studies to meet the main objective. Our research also has some limitations. It focused on a single-centre analysis of data concerning patients and care activities in the GHICL orthogeriatric unit. This limits our ability to generalize GPs’ expectations and recommendations to all orthogeriatric units. Due to the small number of respondents familiar with orthogeriatric units, it is difficult to extrapolate their impressions from interactions with the perioperative orthogeriatric unit. There may well have also been some memory bias when answering the questions, which is inherent to the questionnaire-based study method. Conclusions Each year the number of falls and fragility fractures increases in older adults due to population ageing. It is now recommended and essential to optimize the care of older patients in orthogeriatric units and to liaise with GPs, who are absolutely key to home monitoring. Our research highlights two potential areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients’ care. These areas for improvement will help to optimize care pathways for older adults by coordinating care more efficiently between hospital services and home care providers. Declarations Funding No funds, grants, or other support was received for this project. Conflict of interest On behalf of all authors, the corresponding author states that there is no confict of interest. Ethical approval Consent for the proposed research was given on 14 December 2022 by the GHICL Internal Research Ethics Committee - IRB 00013355. 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VISADE","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBAC9gYehgMghn178zGwCBs7AS08B6BaDHiOpTEwJAC1MBOhBQwMJHLMwFoYCGphP3vwwMcdDInbJXK+Pfj4Y5s8HzMD44ePOXi08OQlHJx5hiFxZ8/b7YYzEm4btjEzMEvO3IZbiz1DjsFh3jYGY4bjudukeRJuMwK1sDHz4tHCw//G4PBfkJYDOc9AWuwJa5EA2sLYxiBncCKHDaQlkQgt7xIO9gK1SPYcM5OckXY7uY2ZsRmvX3j4cw9/+NkGpNmbn0l8sLltO7+9+eCHj3i0QMF/ZA5jA0H1o2AUjIJRMArwAwC1WU5vhuxOjQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-6476-4195","institution":"Lille Catholic Institute Hospital Group: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":true,"prefix":"","firstName":"Fabien","middleName":"","lastName":"VISADE","suffix":""},{"id":263632046,"identity":"8dba1ee8-64c4-4498-8888-7cd4c8176b22","order_by":1,"name":"Simon Havet","email":"","orcid":"","institution":"Lille University Hospital: Centre Hospitalier Universitaire de Lille","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Havet","suffix":""},{"id":263632047,"identity":"4df4b44f-9479-40b6-8b76-24094468508c","order_by":2,"name":"Pierre Robinet","email":"","orcid":"","institution":"Lille Catholic University Saint Philibert Hospital: Universite Catholique de Lille Hopital Saint Philibert","correspondingAuthor":false,"prefix":"","firstName":"Pierre","middleName":"","lastName":"Robinet","suffix":""},{"id":263632048,"identity":"b41ec9e7-4fa7-4e92-b977-9f1731b3aaa1","order_by":3,"name":"François Maladry","email":"","orcid":"","institution":"Lille Catholic University Saint Philibert Hospital: Universite Catholique de Lille Hopital Saint Philibert","correspondingAuthor":false,"prefix":"","firstName":"François","middleName":"","lastName":"Maladry","suffix":""},{"id":263632049,"identity":"92458385-fad3-491b-8e32-a0779f9793ca","order_by":4,"name":"Quentin D'Hulster","email":"","orcid":"","institution":"Lille Catholic Institute Hospital Group: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":false,"prefix":"","firstName":"Quentin","middleName":"","lastName":"D'Hulster","suffix":""},{"id":263632050,"identity":"cb7a95a6-0f4f-49af-af72-c73356aeec5e","order_by":5,"name":"Alexandre Lerooy","email":"","orcid":"","institution":"Lille Catholic Institute Hospital Group: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":false,"prefix":"","firstName":"Alexandre","middleName":"","lastName":"Lerooy","suffix":""},{"id":263632051,"identity":"d89b08c6-02ff-4ef2-b65f-7cc32f9ae5d7","order_by":6,"name":"Pierre Maciejasz","email":"","orcid":"","institution":"Lille Catholic Institute Hospital Group: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":false,"prefix":"","firstName":"Pierre","middleName":"","lastName":"Maciejasz","suffix":""},{"id":263632052,"identity":"17662e57-d5a0-4832-9bad-5dc1f8bed3fc","order_by":7,"name":"Louis Rousselet","email":"","orcid":"","institution":"Groupement des Hôpitaux de l'Institut Catholique de Lille: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":false,"prefix":"","firstName":"Louis","middleName":"","lastName":"Rousselet","suffix":""},{"id":263632053,"identity":"81adde46-49b3-4631-a96d-5c0846928a32","order_by":8,"name":"Cristian Preda","email":"","orcid":"","institution":"Lille Catholic Institute Hospital Group: Groupement des Hopitaux de l'Institut Catholique de Lille","correspondingAuthor":false,"prefix":"","firstName":"Cristian","middleName":"","lastName":"Preda","suffix":""}],"badges":[],"createdAt":"2023-12-12 14:51:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3744450/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3744450/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49089736,"identity":"5d513865-7262-414a-a7ca-e628467df3f3","added_by":"auto","created_at":"2024-01-03 01:39:41","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":350379,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverview of the multi-method study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhases 1 and 2 were carried out simultaneously\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThese were followed by phase 3\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3744450/v1/bca5344074498e7244709287.jpeg"},{"id":49806155,"identity":"fe401379-11d4-4d59-a028-ada6e2c1c11c","added_by":"auto","created_at":"2024-01-18 10:24:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":453233,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3744450/v1/7385a295-d2e9-4289-a064-8f1f12848dca.pdf"}],"financialInterests":"","formattedTitle":"Improving practices in orthogeriatric care services: a multi-method study","fulltext":[{"header":"Key summary points","content":"\u003cp\u003e\u003cstrong\u003eAim\u0026nbsp;\u003c/strong\u003eto explore general practitioners\u0026rsquo; expectations regarding the care of older patients hospitalized in an orthogeriatric unit to highlight possible areas for improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u0026nbsp;\u003c/strong\u003ehighlighted two areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients\u0026rsquo; care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage\u0026nbsp;\u003c/strong\u003eThese areas for improvement will help to optimize care pathways for older adults by coordinating care more efficiently between hospital services and home care providers.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eOrthogeriatric units offer coordinated care for fracture traumas in older adults, provided by a range of healthcare providers including orthopaedic surgeons and geriatricians [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The most common problem treated in orthogeriatric units is proximal femoral fracture caused by a fall [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The many benefits with this type of care include lower mortality rates and preventing loss of functional autonomy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], confusional state and falls [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany hospitals now have orthogeriatric units that are integrated into the care pathway for older patients with fracture traumas. When the patient is discharged, the general practitioner plays a key part in the surgery recovery process, for example by ensuring that the patient is able to stay at home or by following up on specialist consultations. In addition, the combination of interventions and the involvement of hospital and community practitioners gives better results, such as improving the recovery of physical functions and nutritional status [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is therefore important to know whether the care provided in orthogeriatric units is satisfactory to general practitioners. No feedback has been provided to date, and it is important to know the opinions of primary care providers to be able to improve our practices and the care of older patients staying in orthogeriatric units.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to explore general practitioners\u0026rsquo; expectations regarding the care of older patients hospitalized in an orthogeriatric unit to highlight possible areas for improvement.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eWe conducted a multi-method study. This type of research was used to precisely identify areas for improvement. Using a questionnaire-based study, we analyzed general practitioners\u0026rsquo; expectations regarding the care of patients hospitalized in an orthogeriatric unit. Using a quantitative study, we analyzed orthogeriatric unit data available from the Lille Catholic Institute Hospital Group (GHICL). This made it possible to quantify what was offered to patients during their stay in the orthogeriatric unit. The two studies provided different but complementary results. The results of the questionnaire and quantitative study were compared and discussed to meet the main objective. The study design is available in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003eConsent for the proposed research was given on 14 December 2022 by the GHICL Internal Research Ethics Committee - IRB 00013355. The latter validated the regulatory and ethical compliance of the research. The data collected is appropriate and relevant, and limited to what is necessary for the purposes described. The data was collected and stored securely. SPHINX software (Python Documentation Generator) was used for the questionnaire, guaranteeing the participants\u0026rsquo; anonymity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire-based study\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eThe study population\u003c/h2\u003e \u003cp\u003eAll general practitioners and junior doctors practising general medicine in the \u003cem\u003eNord\u003c/em\u003e department of the \u003cem\u003eHauts-de-France\u003c/em\u003e region in France were able to participate. They were invited to take part via a letter explaining the study and what the orthogeriatric unit is. This letter was sent by email, to the Facebook group and by post with orthogeriatric unit hospitalization reports. A QR code was also sent providing a link to directly access the questionnaire. A note explaining what the orthogeriatric unit is was provided with the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e The questionnaire had open and closed-ended questions for participants to express themselves freely. It was created by the research team who reached a consensus on the items to include. There were two versions of the questionnaire, one for GPs and another for junior doctors practising general medicine.\u003c/p\u003e \u003cp\u003eThe GP questionnaire included 14 items divided into two parts with seven items each. The first part concerned GPs\u0026rsquo; expectations of care in an orthogeriatric unit: to facilitate post-trauma physiotherapy; reduce the risk of institutionalization; help them receive osteoporosis care; help them receive geriatric care; facilitate direct admissions for repeat hospitalizations; reduce the risk of mortality; improve the psychological well-being of patients after a fracture. The second part concerned recommendations for improving orthogeriatric unit activities: early social and family environment assessments; early assessment of equipment in the place of residence; improving communication with GPs; improving communication with home nurses; improving communication with occupational therapists; improving communication with the family before discharge. Both parts of the questionnaire ended with a free open-ended item.\u003c/p\u003e \u003cp\u003eThe questionnaire for junior doctors practising general medicine asked whether they had ever worked in an orthogeriatric unit. If so, they could talk freely about their experience. If not, they were asked whether they thought it would be useful for their future practice to spend part of their training in an orthogeriatric unit.\u003c/p\u003e \u003cp\u003eThe questionnaire was hosted on the Sphinx online software. Participants could answer the questionnaire from 24 January to 31 March 2023 included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe answers to all of the questions were qualitative. Numbers and frequencies were calculated for each question. R software was used to perform these analyses. The answers to open-ended questions were analyzed by the research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eThe quantitative study\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eThe study population\u003c/h2\u003e \u003cp\u003eData was collected from patients at least 75 years old hospitalized in an orthogeriatric unit between April 2021 and June 2022. Eligible patients were identified by the Medical Information Department.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData extraction\u003c/h2\u003e \u003cp\u003eThe extracted data was coded according to the international classification of diseases (ICD-10). It was transcribed as medical data by the principal investigators (SH and FV) according to current recommendations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The patients\u0026rsquo; quantitative and qualitative variables were collected: sociodemographic criteria, care pathway, surgical procedures, medical diagnoses and the care providers working in the perioperative orthogeriatric unit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe statistical unit was the patient\u0026rsquo;s stay in the orthogeriatric unit. A stay was defined as a patient\u0026rsquo;s admission to the orthogeriatric unit. First of all, a descriptive analysis of the quantitative and qualitative data was carried out. Categorical variables were expressed as a frequency (percentage). Continuous variables were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation in case of a normal distribution or as the median [interquartile range]. Normal data distributions were verified graphically and by applying the Shapiro-Wilk test. All analyses were performed using R software (version 3.4.3) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the two studies\u0026rsquo; results\u003c/h2\u003e \u003cp\u003eThe purpose of this step was to combine the results of the questionnaire and quantitative study to reach a conclusion in line with the main objective. To do this, the researchers (SH and FV) compared each questionnaire answer to the data extracted from the quantitative study. This was to find out whether any of the GPs\u0026rsquo; expectations or recommendations mentioned in the questionnaire answers matched data in the orthogeriatric unit database. If they did, they were not considered an area for improvement because the orthogeriatric unit was already aware of this expectation. If there was no match, we considered this a possible area for improvement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eResults of the questionnaire-based study\u003c/h2\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003ePopulation\u003c/h2\u003e\n \u003cp\u003eA total 51 GPs answered the questionnaire, including 20 junior doctors practising general medicine. The majority of GPs were women (n\u0026thinsp;=\u0026thinsp;16, 51.6%), mostly between 30 and 40 years old (n\u0026thinsp;=\u0026thinsp;13, 41.9%), tending to work in a semi-rural location (n\u0026thinsp;=\u0026thinsp;21, 67.7%). Their characteristics are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The junior doctors practising general medicine included more women than men (n\u0026thinsp;=\u0026thinsp;12, 60%), and most were under 30 years old (n\u0026thinsp;=\u0026thinsp;18, 90%).\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of general practitioners answering the study questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003eN=31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eGender (female) \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e16 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years) \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003cp\u003e\u0026gt;60\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 \u0026ndash; 40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 \u0026ndash; 50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 \u0026ndash; 60\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e10 (32.3)\u003c/p\u003e\n \u003cp\u003e2 (6.5)\u003c/p\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003cp\u003e2 (6.5)\u003c/p\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eType of practice \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSemi-rural\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003cp\u003e21 (67.7)\u003c/p\u003e\n \u003cp\u003e9 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eYears of practice \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 \u0026ndash; 20 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 \u0026ndash; 5 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 \u0026ndash; 10 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003cp\u003e4 (12.9)\u003c/p\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eAcademic gerontology training (\u003cem\u003eyes)\u003c/em\u003e \u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e2 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eEstimated percentage for each patient age group \u003cem\u003eMedian [Q1-Q3]\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0 \u0026ndash; 18 years\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 \u0026ndash; 30\u003c/p\u003e\n \u003cp\u003e30 \u0026ndash; 65\u003c/p\u003e\n \u003cp\u003e\u0026gt;65\u003c/p\u003e\n \u003cp\u003e\u0026gt;75 polypathological\u003c/p\u003e\n \u003cp\u003eElderly nursing home\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e20 [15; 30]\u003c/p\u003e\n \u003cp\u003e15 [15; 22.5]\u003c/p\u003e\n \u003cp\u003e30 [20; 32]\u003c/p\u003e\n \u003cp\u003e20 [10; 27.5]\u003c/p\u003e\n \u003cp\u003e10 [4.5; 14.5]\u003c/p\u003e\n \u003cp\u003e1 [0; 5]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e[Q1 \u0026ndash; Q3]: interquartile range\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eAnswers to the questionnaire\u003c/h2\u003e\n \u003cp\u003eAll 31 GPs answering the questionnaire expected the perioperative orthogeriatric unit to reduce the risk of their patients being institutionalized. The vast majority (30 (96.8%)) of GPs expected the orthogeriatric unit stay to facilitate physical therapy after trauma surgery. Around half (17 (55%)) expected the orthogeriatric unit to help their patients receive osteoporosis care. Thirty (96.8%) GPs advised improving communication with primary care providers. Twenty (64.5%) GPs felt that communication with occupational therapists needed to be improved. Nineteen junior doctors practising general medicine had never worked in an orthogeriatric unit, and 8 (42%) believed that spending part of their training in an orthogeriatric unit would be useful for their future practice. The details of the answers are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnswers to the study questionnaire\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;31\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExpectations of GPs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFacilitate physiotherapy after trauma surgery \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduce the risk of institutionalization \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHelp patients receive osteoporosis care \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHelp patients receive geriatric care \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFacilitate repeat hospitalization (direct admission if necessary) \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduce the risk of mortality \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove the psychological well-being of patients after their fracture episode \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGP recommendations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly social and family environment assessment \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly assessment of equipment in the place of residence \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove communication with general practitioners \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove communication with nurses \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove communication with physiotherapists \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove communication with occupational therapists \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove communication with the family before discharge \u003cem\u003e(yes) N (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThe analysis of the verbatim comments highlighted one priority in particular: the liaison between community care and hospital care, which GPs stressed is important for better patient care:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ldquo;\u003c/strong\u003e \u003cstrong\u003ecoordinated care of older polypathological patients\u0026rdquo; (1 GP)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ldquo;\u003c/strong\u003e \u003cstrong\u003eteamwork for communicating and coordinating with orthopaedic surgeons and anaesthetists\u0026rdquo; (1 GP)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ldquo;to help them return home: incorporate the GP into their care pathway\u0026rdquo; (1 GP)\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eResults of the quantitative study\u003c/h2\u003e\n \u003cp\u003eBetween April 2021 and June 2022, 355 stays including a single admission to the orthogeriatric unit were analyzed. The mean age of patients admitted to the orthogeriatric unit was 87 years (standard deviation\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8). The majority of patients were women (n\u0026thinsp;=\u0026thinsp;292, 82%). For most stays, patients came from their home (n\u0026thinsp;=\u0026thinsp;291, 82%). Most of the surgical procedure codes were for a hip joint replacement and femoral osteosynthesis. Most of the medical diagnosis codes were for undernutrition (n\u0026thinsp;=\u0026thinsp;226, 64%) and vitamin D deficiency (n\u0026thinsp;=\u0026thinsp;247, 70%). Only 13 stays (4%) were coded for osteoporosis. The main care providers working in the orthogeriatric unit were physiotherapists (n\u0026thinsp;=\u0026thinsp;281, 79%), social workers (n\u0026thinsp;=\u0026thinsp;189, 53%) and dieticians (n\u0026thinsp;=\u0026thinsp;138, 39%). Details of the results of the quantitative analysis are shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of the quantitative analysis of the extracted data coded according to the international classification of diseases (ICD-10)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;355\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender (female), N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e292 (82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlace of residence, N (%)\u003c/p\u003e\n \u003cp\u003eOwn home\u003c/p\u003e\n \u003cp\u003eElderly nursing home\u003c/p\u003e\n \u003cp\u003eRetirement home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e291 (82)\u003c/p\u003e\n \u003cp\u003e37 (10.4)\u003c/p\u003e\n \u003cp\u003e24 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecent hospitalization (\u0026lt;\u0026thinsp;6 months) (yes), N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e278 (78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReason for discharge from perioperative orthogeriatric unit, N (%)\u003c/p\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003cp\u003eReturn home\u003c/p\u003e\n \u003cp\u003eOther short-term hospital care unit\u003c/p\u003e\n \u003cp\u003eFollow-up care and rehabilitation facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003cp\u003e133 (37.5)\u003c/p\u003e\n \u003cp\u003e31 (8.7)\u003c/p\u003e\n \u003cp\u003e184 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of hospital stay (days), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.8 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of stay in perioperative orthogeriatric unit (days), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime to admission to perioperative orthogeriatric unit (days), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndernutrition*, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e226 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitamin D deficiency, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e247 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMajor neurocognitive disorders, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRepeat falls**, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteoporosis, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBed sores, N (%)\u003c/p\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003cp\u003eStage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (13)\u003c/p\u003e\n \u003cp\u003e34 (10)\u003c/p\u003e\n \u003cp\u003e10 (3)\u003c/p\u003e\n \u003cp\u003e2 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfections with antibiotics prescribed, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnaemia requiring transfusion, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemoral fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e283 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCervical spine fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoracic spine and/or rib fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLumbar spine and/or pelvic fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShoulder and/or arm fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWrist and/or hand fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeg and/or ankle fracture, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHip joint replacement surgery, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemoral osteosynthesis surgery, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteosynthesis surgery on the forearm bone, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteosynthesis surgery on the humerus, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther***, N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101 (28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCare providers working in the perioperative orthogeriatric unit, N (%)\u003c/p\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003cp\u003eFoundation doctor\u003c/p\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003cp\u003eDietitian\u003c/p\u003e\n \u003cp\u003eSpeech therapist\u003c/p\u003e\n \u003cp\u003ePsychologist\u003c/p\u003e\n \u003cp\u003ePharmacist\u003c/p\u003e\n \u003cp\u003ePedicurist-podiatrist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e353 (99.4)\u003c/p\u003e\n \u003cp\u003e319 (90)\u003c/p\u003e\n \u003cp\u003e281 (79)\u003c/p\u003e\n \u003cp\u003e189 (53)\u003c/p\u003e\n \u003cp\u003e138 (39)\u003c/p\u003e\n \u003cp\u003e36 (10)\u003c/p\u003e\n \u003cp\u003e15 (4)\u003c/p\u003e\n \u003cp\u003e6 (1.7)\u003c/p\u003e\n \u003cp\u003e2 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003eSD: Standard deviation\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e* Loss of 5% of weight in one month, or 10% of weight in 6 months\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e** \u0026gt;2 falls in one year\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e*** Either orthopaedic treatment or other type of surgery not sought in the analyses (ankle for example)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of the two studies\u0026rsquo; results\u003c/h2\u003e\n \u003cp\u003eSome GPs\u0026rsquo; answers to the questionnaire recommended activities already offered in the orthogeriatric unit. For example, the data from the quantitative study confirmed that staying in a perioperative orthogeriatric unit facilitated physical therapy after trauma surgery, since more than half of the stays (n\u0026thinsp;=\u0026thinsp;184, 51.8%) resulted in discharge to a follow-up care and rehabilitation facility. Similarly, when GPs recommended an early assessment of equipment in the place of residence, the data from the quantitative study confirmed that there was a social worker visit for more than half of the stays (n\u0026thinsp;=\u0026thinsp;189, 53%).\u003c/p\u003e\n \u003cp\u003eThe GPs had diverging opinions over certain questionnaire items, two of which can be considered possible areas for improvement for orthogeriatric units. Not all GPs agreed that the orthogeriatric unit helps patients to receive osteoporosis care (17 GPs (55%)), or that it was important to facilitate communication with occupational therapists (20 GPs (64.5%)). This was consistent with the data from the quantitative study, as only 13 stays (4%) were coded with an osteoporosis diagnosis, and there was no occupational therapist code during the stay.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study sought to analyze GPs\u0026rsquo; expectations regarding the care of older patients hospitalized in orthogeriatric units and identify areas for improvement. All GPs expected a stay in the orthogeriatric unit to facilitate physical therapy, reduce the risk of institutionalization, and reduce mortality. The majority of GPs agreed that the liaison between hospital care and primary care should remain a priority of patient care in orthogeriatric units. Lastly, comparing the results of the questionnaire and quantitative study highlighted two areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients\u0026rsquo; care.\u003c/p\u003e \u003cp\u003eWe are not the first to highlight the lack of osteoporosis screening in orthogeriatric units. In a meta-analysis in 2020, Van Camp et al. showed that the care provided in orthogeriatric units was rarely associated with more osteoporosis diagnoses or the introduction of calcium and vitamin D supplements and osteoporosis medications [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the general population there is also a discrepancy between the number of older adults treated for osteoporosis and the proportion of people considered eligible for treatment according to their fracture risk [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Based on the conservative assumption that treatments are only given to high-risk patients, international and European prescribing data suggests that more than 57% of high-risk women do not receive any treatment specifically for their bones [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Osteoporosis is a public health problem due to its frequency and population ageing. In orthogeriatric units, the majority of patients have osteoporosis, which is logical as in most cases they are older patients with fractures resulting from low-energy falls [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study confirms, once again, that osteoporosis screening must be improved for older patients, especially in orthogeriatric units. GPs are also on the front line, as they are responsible for the patients\u0026rsquo; long-term follow-up. Orthogeriatric units could offer automatic screening and care procedures to improve the screening and monitoring of osteoporosis patients. If these procedures are already in place, this practice should be evaluated. One solution could be to automatically implement treatment during an orthogeriatric unit stay and, if this is not possible, always liaise with GPs to ensure the treatment is implemented at home. A study by Harwood et al. in 2004 proved that giving vitamin D supplements to women staying at an orthogeriatric unit for a proximal femoral fracture reduced the risk of falls in the following year [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In that study, 70% of patients had a vitamin D deficiency, consistent with the characteristics of our study\u0026rsquo;s patients (70% of stays), confirming the need to take effective measures to prevent diseases linked to fragile bones.\u003c/p\u003e \u003cp\u003eWe are not the first to highlight that improving communication with occupational therapists in perioperative orthogeriatric units is another possible area for improvement. In a study in 2023, Jasper et al. showed that the sedentary lifestyle of older patients, particularly in orthogeriatric units, was a real problem limiting early physical therapy, and that one possible solution was to involve occupational therapists in their care [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Indeed, occupational therapists play a key role in the care of older patients in orthogeriatric units. They improve and speed up rehabilitation for patients losing their autonomy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and patients who have just had surgery after a fracture.\u003c/p\u003e \u003cp\u003eThe way occupational therapists are involved in these patients\u0026rsquo; care, whether in hospital or at home, must also be reviewed. Training healthcare providers such as occupational therapists from the start of their careers would help them to understand the particularities of care for older patients. This is an interesting idea that has already been suggested [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another solution would be to involve occupational therapists after patients are discharged from the orthogeriatric unit. This goes without saying for patients being discharged to a follow-up care and rehabilitation facility, but does not necessarily happen when patients return home or to a nursing home (which is the case for 37.5% of the stays in our study). Involving the GP to ensure that patients discharged home benefit from occupational therapy is therefore an aspect of care that can be improved.\u003c/p\u003e \u003cp\u003eThe quantitative study databases were of high quality. The characteristics of patients treated in the orthogeriatric unit in our study were generally similar to what is described in one of the most cited orthogeriatric studies, which adds external validation to our results (7). What was innovative about our research was that it was able to converge the results of the two complementary studies to meet the main objective.\u003c/p\u003e \u003cp\u003eOur research also has some limitations. It focused on a single-centre analysis of data concerning patients and care activities in the GHICL orthogeriatric unit. This limits our ability to generalize GPs\u0026rsquo; expectations and recommendations to all orthogeriatric units. Due to the small number of respondents familiar with orthogeriatric units, it is difficult to extrapolate their impressions from interactions with the perioperative orthogeriatric unit. There may well have also been some memory bias when answering the questions, which is inherent to the questionnaire-based study method.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEach year the number of falls and fragility fractures increases in older adults due to population ageing. It is now recommended and essential to optimize the care of older patients in orthogeriatric units and to liaise with GPs, who are absolutely key to home monitoring. Our research highlights two potential areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients\u0026rsquo; care. These areas for improvement will help to optimize care pathways for older adults by coordinating care more efficiently between hospital services and home care providers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNo funds, grants, or other support was received for this project.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn behalf of all authors, the corresponding author states that there is no confict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for the proposed research was given on 14 December 2022 by the GHICL Internal Research Ethics Committee - IRB 00013355.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChong CP, Savige J, Lim WK (2009) Orthopaedic-geriatric models of care and their effectiveness. Australas J Ageing Dec 28(4):171\u0026ndash;176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHempsall VJ, Robertson DR, Campbell MJ, Briggs RS (1990) Orthopaedic geriatric care\u0026ndash;is it effective? A prospective population-based comparison of outcome in fractured neck of femur. J R Coll Physicians Lond Jan 24(1):47\u0026ndash;50\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePioli G, Giusti A, Barone A (2008) Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res Apr 20(2):113\u0026ndash;122\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiusti A, Barone A, Razzano M, Pizzonia M, Pioli G (2011) Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med 47(2):281\u0026ndash;296 PMID: 21555985\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U et al (2010) Ortho-geriatric service\u0026mdash;a literature review comparing different models. Osteoporos Int Dec 21(S4):637\u0026ndash;646\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFischer H, Maleitzke T, Eder C, Ahmad S, St\u0026ouml;ckle U, Braun KF (2021) Management of proximal femur fractures in the elderly: current concepts and treatment options. Eur J Med Res 4 Aug 26(1):86\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K et al (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. The Lancet Apr 385(9978):1623\u0026ndash;1633\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePueyo-S\u0026aacute;nchez MJ, Larrosa M, Sur\u0026iacute;s X, S\u0026aacute;nchez-Ferrin P, Bullich-Marin I, Frigola-Capell E et al (2018) Association of orthogeriatric services with long-term mortality in patients with hip fracture. Eur Geriatr Med Apr 9(2):175\u0026ndash;181\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams AL, Schiff MA, Koepsell TD, Rivara FP, Leroux BG, Becker TM et al (2010) Oct. Physician Consultation, Multidisciplinary Care, and 1-Year Mortality in Medicare Recipients Hospitalized with Hip and Lower Extremity Injuries: (See Editorial Comments by Dr. David B. Reuben, pp\u0026nbsp;2022\u0026ndash;2023). J Am Geriatr Soc. ;58(10):1835\u0026ndash;42\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArinzon Z, Fidelman Z, Zuta A, Peisakh A, Berner YN (2005) Functional recovery after hip fracture in old-old elderly patients. Arch Gerontol Geriatr May 40(3):327\u0026ndash;336\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLundstr\u0026ouml;m M, Edlund A, Karlsson S, Br\u0026auml;nnstr\u0026ouml;m B, Bucht G, Gustafson Y (2005) A Multifactorial Intervention Program Reduces the Duration of Delirium, Length of Hospitalization, and Mortality in Delirious Patients. J Am Geriatr Soc Apr 53(4):622\u0026ndash;628\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta-Martins I, Carreteiro J, Santos A, Costa-Martins M, Artilheiro V, Duque S et al (2021) Post-operative delirium in older hip fracture patients: a new onset or was it already there? Eur Geriatr Med Aug 12(4):777\u0026ndash;785\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhang JK, Lim ZY, Yee WQ, Tan CYF, Kwan YH, Low LL (2023) Post-surgery interventions for hip fracture: a systematic review of randomized controlled trials. BMC Musculoskelet Disord 25 May 24(1):417\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGates M, Pillay J, Nuspl M, Wingert A, Vandermeer B, Hartling L (Mar 2023) Screening for the primary prevention of fragility fractures among adults aged 40 years and older in primary care: systematic reviews of the effects and acceptability of screening and treatment, and the accuracy of risk prediction tools. 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BMJ Open Mar 8(3):e020617\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3744450/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3744450/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eOrthogeriatric units have proven to be relevant in the care of older patients. A combination of hospital and community care is recommended for optimized care when these older patients return home. However, general practitioners (GPs) have not provided any feedback on this. The aim of this study was to look at GPs\u0026rsquo; opinions on the care provided in orthogeriatric units to identify areas for improvement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eMulti-method study combining one phase comprised of a retrospective analysis of data on older patients hospitalized in an orthogeriatric unit, and another phase analyzing GPs\u0026rsquo; answers to a questionnaire. By comparing the results of the two analysis phases we were able to identify areas for improvement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e355 hospital stays were analyzed. The mean age of the older patients was 87 years (SD\u0026thinsp;=\u0026thinsp;5.8), and patients were predominantly women (n\u0026thinsp;=\u0026thinsp;292, 82%). The most common surgery performed was femur surgery (n\u0026thinsp;=\u0026thinsp;240, 68%). Patients suffered from undernutrition (n\u0026thinsp;=\u0026thinsp;226, 64%), a vitamin D deficiency (n\u0026thinsp;=\u0026thinsp;247, 70%) and chronic falls (n\u0026thinsp;=\u0026thinsp;55, 16%). The questionnaire was completed by 51 GPs. Comparing the results of the retrospective analysis and questionnaire identified two areas for improvement: (i) helping patients receive osteoporosis care; (ii) involving occupational therapists more during the orthogeriatric unit stay.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eImprovements in practices are always needed, especially when caring for older patients. In orthogeriatric units, this care must involve occupational therapists more and improve screening and treatment for osteoporosis.\u003c/p\u003e","manuscriptTitle":"Improving practices in orthogeriatric care services: a multi-method study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 01:39:37","doi":"10.21203/rs.3.rs-3744450/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e8426e7-673d-46d6-b5b6-8adb97573c81","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-18T10:16:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 01:39:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3744450","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3744450","identity":"rs-3744450","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}