Fracture unit: a (possible) model of implementation in Italy.

The "Fracture Unit" is one of the possible answers to the advanced health needs of the growing number of elderly in our Country, aimed at achieving effective and efficient management of fracture events due to osteoporosis or fragility fractures. Here we proposed an implementation model that can represent an ideal and virtuous path that should be dedicated to every fractured patient. This model should provide specific responses to the health needs of the fractured patient and specifically responses to the health needs of the subject as a frail patient. The goal of this model is therefore to define and structure "a priori" a multidisciplinary course where the patient should be automatically inserted at the time of contact with the health facility following the fracture event, to establish a similar structured course even for the post-acute phase, that is taken over by large social-health areas or districts; and meet the cost for the definition of the rehabilitation.An optimal communication between hospital and general practitioners, responsible necessarily of the continuous reassessment of the patient, and the monitoring of patient's adherence to treatment are needed for a successful outcome and application of the implementation's model.

The bone care nurse project.

In today's society, citizens are called to play an increasingly active role in decision planning related to the various aspects of work, social and political life. This trend has been also confirmed in the health's field. In fact, the citizen is also required to have the skills to take responsibility for his/her own health, to have knowledge of the health care system, understand the advice and instructions of health professionals, actively participating with them in the therapeutical path. The lack or an inadequate level of these skills will affect both the health of the individual and the costs related to the National Health System. The nursing staff that interfaces between physicians and patients plays a key role in health's promotion as an important determinant of health and welfare of the patient-citizen. With regard to osteoporosis, due to better knowledge of its determining causes, it is now possible an easy access to diagnosis and treatment options before fragility fractures occur, providing a real prevention to such complications. Prevention must be addressed to two different, but related, objectives: 1) prevention of osteoporosis; and 2) prevention of fragility fractures in patients with osteoporosis. In the context of both primary and secondary prevention, the nurse can better informed the patients and/or citizens about either the risks related to an inappropriate behavior or situations and events particularly dangerous to health, as well as provide information to simply and effectively implement protective measures. This project aims to raise awareness and create competent and specialized nurse figures, with a good understanding of the bone diseases, through the organization of seminars and training courses. Thus, it will be create clinical pathways and welfare in which the figure of the "Bone Care Nurse" will be responsible for administration of questionnaires relating to lifestyle and, for patients in drug treatment, questionnaires designed to assess the relevance of the adherence/compliance to the prescribed therapy. The "Bone Care Nurse" will also provide specific information leaflets aimed at improving lifestyle, compliance and adherence to therapy prescribed by physician. Specifically, this program will cover not only the prevention of fragility fractures in patients with low bone mass but also will provide general information on healthy lifestyles, such as adequate diet and physical activity, helpful to prevent cardiovascular disease, diabetes, obesity. An increase patient's compliance in taking the antiosteoporotic therapy, as also other concomitant medications will be obtainable. The information collected will be stored in an electronic database, subject to statistical analysis and will be informative on both the degree of knowledge of disease by the patient at the first and follow-up meetings of the Bone Care Nurse project.