Introduction
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to evaluate the efficacy of an osteoporosis clinical pathway designed to increase rates of follow-up, investigation and treatment for osteoporosis administered in a hospital setting,
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to determine the rates of follow-up by a general practitioner (GP) post-fracture, and subsequent rates of investigation and treatment for osteoporosis,
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to examine the prevalence and source of patient education regarding osteoporosis and osteoporosis-related services,
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to investigate long-term pharmacological osteoporosis prophylaxis use in patients enrolled in the clinical pathway,
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to determine re-fracture rates in these patients,
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to investigate general practitioners compliance with suggested investigations and treatment plans for these patients post-discharge from acute care.
Materials and methods
Phase 1: Comparison of patients before and after pathway introduction
Setting and participants
Intervention
Procedure
Phase 2: Evaluation of the osteoporosis clinical pathway and General Practitioner feedback
Statistical analyses
Results
Patient characteristics
Phase 1 Usual Care | Phase 1 Pathway | Phase 2 Pathway | |
---|---|---|---|
n = 28 | n = 28 | n = 65 | |
Demographics | |||
Age, mean ± SD (yrs)a** | 71.3 ± 13.7 | 79.2 ± 8.4 | 76.17 |
Female (%)a** | 71.4 | 78.6 | 70.8 |
Did not complete high school (%)a* | 57.1 | 78.6 | Not collected |
Resident of nursing home (%) | 14.3 | 32.1 | 15.4 |
Time to interview, mean ± SD (wks) | 55.3 ± 4.4 | 32.7 ± 7.1 | Not collected |
Next-of-kin as respondent (%)a** | 10.7 | 39.3 | 20.0 |
Osteoporosis risk factors | |||
Current smoking (%)b** | 25.0 | 14.3 | 4.6 |
Previous adult fracture (%) | 53.6 | 42.9 | 33.8 |
Family history of fracture (%) | 35.7 | 17.9 | 32.3 |
Osteoporosis investigations
Phase 1 Usual Care | Phase 1 Pathway | Phase 2 Pathway | |
---|---|---|---|
n = 28 | n = 28 | n = 65 | |
Investigation suggested | 32.1 | 39.3 | 29.2 |
Investigation initiated | 32.1 | 35.7 | 26.1 |
DXAa suggested | 25.0 | 28.6 | 27.7 |
DXA conducted | 25.0 | 21.4 | 29.2 |
Vitamin D/calcium test suggested | 17.9 | 35.7 | 29.2 |
Vitamin D/calcium checked | 14.3 | 28.6 | 29.2 |
Osteoporosis medication
Phase 1 Usual care | Phase 1 Pathway | Phase 2 Pathway | ||||
---|---|---|---|---|---|---|
n = 28 | n = 28 | n = 65 | ||||
n | % | n | % | n | % | |
Received information about osteoporosis medicationd**,e** | 8 | 28.6 | 15 | 53.6 | 33 | 50.8 |
Source of information about osteoporosis medicationa
| ||||||
General practitionerc
| 9 | 39.0 | 12 | 36.4 | ||
Hospital pharmacy staff | 6 | 26.0 | 6 | 18.1 | ||
Orthopaedic surgeon | 3 | 13.0 | 6 | 18.1 | ||
Other sources | 3 | 13.0 | 2 | 6.1 | ||
Could not remember | 2 | 9.0 | 7 | 21.3 | ||
Total | 23 | 100.0 | 33 | 100.0 | ||
Any osteoporosis medication prescribedd**,e***,f*** | 7 | 25.0 | 15 | 53.6 | 54 | 83.1 |
Medication commencedb,d**,
| 7 | 100.0 | 13 | 86.7 | 48 | 88.9 |
Medication continuedb
| 6 | 85.7 | 10 | 76.9 | 46 | 95.8 |
General practitioner follow-up
Phase 1 usual care | Phase 1 pathway | Phase 2 pathway | ||||
---|---|---|---|---|---|---|
n = 28 | n = 28 | n = 65 | ||||
n | % | n | % | n | % | |
Saw GP following fractureb*** | 20 | 71.4 | 16 | 57.1 | 57 | 87.6 |
Reasons for not seeing GPa, c
| ||||||
Discharge to rehab hospital | 7 | 28.6 | ||||
Nursing home resident | 3 | 19.0 | ||||
Fracture fixed | 5 | 52.4 | ||||
Other | 5 | 28.6 | ||||
Total | 20 | 100.0 |