Table 3.
Macrophase 3: care process of diagnosis and treatment (secondary prevention of refracture)
| 3. Care process of diagnosis and treatment | |||
|---|---|---|---|
| Activities | Description | In charge | Documents/checks |
| Outpatient examination with diagnostic framing | The internist/specialist or orthopedic physician clinically evaluates the patient with bone fragility |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Paper medical record • Electronic medical record on database hospital company/ territorial service/ private facility • Excel document in hospital PC • Excel document maintained on company server • Other |
| Evaluation or represcription of level I exams performed (+ any level II exams) | The internist/specialist or orthopedic physician evaluates the Level I exams (Level II exams, if any) performed; if necessary, represcribes them, if not performed, or prescribes additional ones if further study is needed |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Paper medical record • Electronic medical record on database hospital company/ territorial service/ private facility • Excel document in hospital PC • Excel document maintained on company server • Other |
| Assessment or represcription supplementation (vitamin D and possible calcium) | Internist/Specialty Physician or Orthopedist verifies proper vitamin D supplementation and calcium nutritional intake; represcribes/corrects dosage where suboptimal |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Paper medical record • Electronic medical record on database hospital company/ territorial service/ private facility • Excel document in hospital PC • Excel document maintained on company server • Other |
| Performance of instrumental examinations (DEXA and vertebral morphometry) | Radiologic technical staff performs instrumental examinations where present in the department or in the immediate vicinity ("in-house") and delivers the report to the medical staff |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Verification by inspection • Verification on electronic diary hospital/territorial service/private facility • Excel document in hospital PC • Excel document maintained on company server • Other |
| Prescription of anti-fracture therapy (according to note 79) |
The Internist/Specialist Physician or Orthopedist, having verified the optimal vitamin D and nutritional status, prescribes antifracturative drugs according to Note 79, verifying the absence of contraindications; draws up appropriate ministerial treatment plan where the therapeutic choice falls on subcutaneously administered drugs (teriparatide, denosumab) |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Electronic medical record on database hospital company/territorial service/private facility • Excel document in hospital PC • Excel document maintained on company server • Other |
| Performance/programming of drug therapy in Band H (according to note 79) | The Internist/Specialist Physician or Orthopedist, when indicated, prescribes intravenous antifracture therapy (zoledronic acid) that can be administered in the accredited public hospital, community service, or private facility setting only |
Orthopedist Orthogeriatrician Internist Endocrinology specialist Rheumatology specialist Physiatrist specialist Nursing staff Technical staff |
• Electronic reservation agenda of the hospital/territorial service/private facility information system • Use of local booking software (internal diaries) • Manual appointment book Nursing records • Paper Medical Record • Electronic medical record on hospital/territorial service company database • Excel document in hospital PC • Excel document maintained on company server • Other |