Fragility fractures of the hip have serious consequences; 25% of hip fracture patients in the UK die within a year and survivors have a reduction in their health-related quality of life similar to having a stroke. The outlook is likely to be even worse for people in low- and middle-income countries (LMIC) with fewer resources to support recovery and long-term care.
The HIPCARE study will compare current treatment pathways for patients with hip fractures to a new model of multidisciplinary care. Multidisciplinary teamwork is rare in LMIC in Asia so the project aims to show whether the model can help improve patient care and quality of life. If so, the aim will be to oversee the implementation of the new care pathway in LMIC including training of healthcare staff from all the relevant disciplines.
Prof. Matt Costa, co-lead of the HIPCARE trial said: ‘We've been setting up this NIHR global health project for a year and a half now and finally reached a point where we could go to the investigators in the Philippines and launch the project. The HIPCARE meeting was hosted by Irewin Tabu, professor of trauma and orthopaedics at the Philippines General Hospital, and an academic at the University of Philippines in Manila. During the visit I was involved in many different activities with the aim of promoting the trial to all the different specialties around the whole country.’
The launch event was held in Manila where investigators from the eight participating hospitals met for the first investigators meeting for HIPCARE. Orthopaedic surgeons, healthcare professionals and research teams involved in the HIPCARE study came from all over the Philippines. A second multi-disciplinary meeting was held with investigators in the city of Ilo Ilo.
As well as the launch of HIPCARE, Matt attended a meeting of the Philippines branch of the fragility fracture network, which is a global organisation promoting multidisciplinary care for patients with fragility fractures. ‘I spoke to the meeting about how we’re trying to use data in real-time and provide feedback to centres to improve their care pathways for patients with fragility fractures of the hip. Treating older people with fractures with a multi-disciplinary team is likely to improve patient outcomes and save money for the healthcare system.’
He also spent a couple of days discussing orthopaedic care with 60 surgeons in Manila as part of an AO course. ‘Patients with a hip fracture in the UK, are admitted under the joint care of an orthopaedic surgeon and geriatric medicine consultant, working with specialist nurses and therapists. However, this is not the case in the Philippines, where patients with a broken hip get admitted by the orthopaedic surgeon. Surgeons are great at fixing broken hips, but not necessarily best placed to look after the multiple medical and social problems that beset older patients with broken bones. This is why we need multi-disciplinary teams,’ said Matt.
Eight public hospitals in each of Nepal, India, Philippines, Thailand and Vietnam will take part in the HIPCARE trial. The four other countries are scheduled to open up to recruitment later this year.