Skip to main content
Erschienen in: Osteoporosis International 3/2010

01.03.2010 | Original Article

Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial

verfasst von: N. Yuksel, S. R. Majumdar, C. Biggs, R. T. Tsuyuki

Erschienen in: Osteoporosis International | Ausgabe 3/2010

Einloggen, um Zugang zu erhalten

Abstract

Summary

This study evaluated the effect of a multifaceted intervention (screening and patient education) by community pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis.

Introduction

The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis.

Methods

In this randomized, controlled trial, 262 patients meeting bone mineral density (BMD) testing guidelines [men or women aged ≥ 65 years or 50–64 years with one major risk factor including previous fracture, family history of osteoporosis, glucocorticoids for > 3 months, or early menopause] were allocated to intervention (129) or control (133). Intervention consisted of printed materials, education, and quantitative ultrasound. Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months.

Results

Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients (22%) compared with 14 controls (11%) (RR 2.1, 95% CI 1.1–3.7). This was driven by BMD testing (28 (22%) vs. 13 (10%) for controls, p = 0.011). Calcium intake increased more among intervention patients than controls (30% vs. 19%, RR 1.6, 95% CI 1.0–2.5). There was no effect on knowledge or quality of life.

Conclusion

A pharmacist screening program doubled the number of patients tested for osteoporosis. Nevertheless, many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed.
Literatur
1.
Zurück zum Zitat Brown JP, Josse RG (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 suppl):S1–S34PubMed Brown JP, Josse RG (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 suppl):S1–S34PubMed
2.
Zurück zum Zitat Papadimitopoulos EA (1997) Current and projected rates of hip fracture in Canada. CMAJ 157(10):1357–1363 Papadimitopoulos EA (1997) Current and projected rates of hip fracture in Canada. CMAJ 157(10):1357–1363
3.
Zurück zum Zitat Cummings SR, Kelsey JL, Nevitt M, O’Dowd K (1985) Epidemiology of osteoporosis and osteoporotic fracture. Epidemiol Rev 7:178–208PubMed Cummings SR, Kelsey JL, Nevitt M, O’Dowd K (1985) Epidemiology of osteoporosis and osteoporotic fracture. Epidemiol Rev 7:178–208PubMed
4.
Zurück zum Zitat Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17SCrossRefPubMed Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17SCrossRefPubMed
5.
Zurück zum Zitat Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822CrossRefPubMed Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822CrossRefPubMed
6.
Zurück zum Zitat Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Jt Surg Am 82:1063–1070 Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Jt Surg Am 82:1063–1070
7.
Zurück zum Zitat Gallagher TC, Gerling O, Comite F (2002) Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 162:450–456CrossRefPubMed Gallagher TC, Gerling O, Comite F (2002) Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 162:450–456CrossRefPubMed
8.
Zurück zum Zitat Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz GH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057CrossRefPubMed Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz GH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057CrossRefPubMed
9.
Zurück zum Zitat Hutchison BG, Abelson J, Woodward CA, Norman G (1996) Preventive care and barriers to effective prevention; how do family physicians see it. Can Fam Physician 42:1693–1700PubMed Hutchison BG, Abelson J, Woodward CA, Norman G (1996) Preventive care and barriers to effective prevention; how do family physicians see it. Can Fam Physician 42:1693–1700PubMed
10.
Zurück zum Zitat Mazanec D (2004) Osteoporosis screening: time to take responsibility. Arch Intern Med 164:1047–1048CrossRefPubMed Mazanec D (2004) Osteoporosis screening: time to take responsibility. Arch Intern Med 164:1047–1048CrossRefPubMed
11.
Zurück zum Zitat Lafata JE, Kolk D, Peterson EL, McCarthy BD, Weiss TW, Chen YT, Muma BK (2007) Improving osteoporosis screening: results from a randomized cluster trial. J Gen Intern Med 22:346–351CrossRefPubMed Lafata JE, Kolk D, Peterson EL, McCarthy BD, Weiss TW, Chen YT, Muma BK (2007) Improving osteoporosis screening: results from a randomized cluster trial. J Gen Intern Med 22:346–351CrossRefPubMed
12.
Zurück zum Zitat Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA, Arnold M, Gauthier S, Avorn J (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815CrossRefPubMed Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA, Arnold M, Gauthier S, Avorn J (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815CrossRefPubMed
13.
Zurück zum Zitat Curtis JR, Westfall AO, Allison AO, Becker A, Melton ME, Feeman A, Keife CI, MacArthur M, Ockershausen T, Stewart E, Weissman G, Saag KG (2007) Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users. Arch Intern Med 167:591–596CrossRefPubMed Curtis JR, Westfall AO, Allison AO, Becker A, Melton ME, Feeman A, Keife CI, MacArthur M, Ockershausen T, Stewart E, Weissman G, Saag KG (2007) Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users. Arch Intern Med 167:591–596CrossRefPubMed
14.
Zurück zum Zitat Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C, Jan S, Patel M, Weiss TW, Chen YT, Brookhart MA (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367CrossRefPubMed Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C, Jan S, Patel M, Weiss TW, Chen YT, Brookhart MA (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367CrossRefPubMed
15.
Zurück zum Zitat Solomon DH, Finkelstein JS, Pollinski JM, Arnold M, Licari A, Cabral D, Canning C, Avorn J, Katz JN (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporosis Int 17:760–67CrossRef Solomon DH, Finkelstein JS, Pollinski JM, Arnold M, Licari A, Cabral D, Canning C, Avorn J, Katz JN (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporosis Int 17:760–67CrossRef
16.
Zurück zum Zitat Ciardulli LM (2003) Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 43(1):61–68CrossRef Ciardulli LM (2003) Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 43(1):61–68CrossRef
17.
Zurück zum Zitat Holdford D, Kennedy DT, Bernadella P, Small R (1998) Implementing disease management in community pharmacy practice. Clin Ther 20(2):328–339CrossRefPubMed Holdford D, Kennedy DT, Bernadella P, Small R (1998) Implementing disease management in community pharmacy practice. Clin Ther 20(2):328–339CrossRefPubMed
18.
Zurück zum Zitat Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, Cave A, Chang WC, Dzavik V, Farris KB, Galvin D, Semchuk W, Taylor JG (2002) A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 162:1149–1155CrossRefPubMed Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, Cave A, Chang WC, Dzavik V, Farris KB, Galvin D, Semchuk W, Taylor JG (2002) A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 162:1149–1155CrossRefPubMed
19.
Zurück zum Zitat Park JJ, Kelly P, Carter BL, Burgess PP (1996) Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc 36:443–451 Park JJ, Kelly P, Carter BL, Burgess PP (1996) Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc 36:443–451
20.
Zurück zum Zitat Pauley TR, Magee MJ, Curry JD (1995) Pharmacist-managed, physician directed asthma management program reduces emergency department visits. Ann Pharmacother 29:5–9PubMed Pauley TR, Magee MJ, Curry JD (1995) Pharmacist-managed, physician directed asthma management program reduces emergency department visits. Ann Pharmacother 29:5–9PubMed
21.
Zurück zum Zitat Hatoum JT, Akhras K (1993) A 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists. Ann Pharmacother 27:1106–1119PubMed Hatoum JT, Akhras K (1993) A 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists. Ann Pharmacother 27:1106–1119PubMed
22.
Zurück zum Zitat Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT (2006) Design of a randomized trial of a community pharmacist-initiated screening and intervention program for osteoporosis—The OsteoPharm Study. CPJ 139(2):50–51 Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT (2006) Design of a randomized trial of a community pharmacist-initiated screening and intervention program for osteoporosis—The OsteoPharm Study. CPJ 139(2):50–51
24.
Zurück zum Zitat Ailinger RL, Emerson J (1998) Women’s knowledge of osteoporosis. Appl Nurs Res 11(3):111–114CrossRefPubMed Ailinger RL, Emerson J (1998) Women’s knowledge of osteoporosis. Appl Nurs Res 11(3):111–114CrossRefPubMed
25.
Zurück zum Zitat Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 29:602–608 Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 29:602–608
26.
Zurück zum Zitat Lydick E, Zimmerman SI, Yawn B, Love B, Kleerekoper M, Ross P, Martin A, Holmes R (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQoL). J Bone Miner Res 12(3):456–463CrossRefPubMed Lydick E, Zimmerman SI, Yawn B, Love B, Kleerekoper M, Ross P, Martin A, Holmes R (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQoL). J Bone Miner Res 12(3):456–463CrossRefPubMed
27.
Zurück zum Zitat Elliott ME, Meek PD, Knaus NL, Schill GR, Weinswig PA, Bohlman JP, Zimpel CL, Jensen BC, Walters DR, Sutters SL, Peterson AN, Peterson RM, Binkley NC (2002) Pharmacy-based bone mass measurement to assess osteoporosis risk. Ann Pharmacother 36:571–577CrossRefPubMed Elliott ME, Meek PD, Knaus NL, Schill GR, Weinswig PA, Bohlman JP, Zimpel CL, Jensen BC, Walters DR, Sutters SL, Peterson AN, Peterson RM, Binkley NC (2002) Pharmacy-based bone mass measurement to assess osteoporosis risk. Ann Pharmacother 36:571–577CrossRefPubMed
28.
Zurück zum Zitat Naunton M, Peterson GR, Jones G (2006) Pharmacist-provided quantitative heel ultrasound for rural women at risk of osteoporosis. Ann Pharmacother 40:38–44PubMed Naunton M, Peterson GR, Jones G (2006) Pharmacist-provided quantitative heel ultrasound for rural women at risk of osteoporosis. Ann Pharmacother 40:38–44PubMed
29.
Zurück zum Zitat Goode JV, Swiger K, Blumi BM (2004) Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from project ImPACT: osteoporosis. J Am Pharm Assoc 44(2):152–160CrossRef Goode JV, Swiger K, Blumi BM (2004) Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from project ImPACT: osteoporosis. J Am Pharm Assoc 44(2):152–160CrossRef
30.
Zurück zum Zitat Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study, Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:629–634CrossRefPubMed Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study, Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:629–634CrossRefPubMed
31.
Zurück zum Zitat Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO (1996) Ultrasonographic heel measurements to predict hip fractures in elderly women: the EPIDOS prospective study. Lancet 348:511–514CrossRefPubMed Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO (1996) Ultrasonographic heel measurements to predict hip fractures in elderly women: the EPIDOS prospective study. Lancet 348:511–514CrossRefPubMed
32.
Zurück zum Zitat Dehart RM, Gonzalez EH (2005) Osteoporosis: point of care testing. Ann Pharmacother 38:473–481 Dehart RM, Gonzalez EH (2005) Osteoporosis: point of care testing. Ann Pharmacother 38:473–481
33.
Zurück zum Zitat Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymovich WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Annals Intern Med 141:366–373 Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymovich WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Annals Intern Med 141:366–373
34.
Zurück zum Zitat Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russel AS, Hanley DA, Morrish DW, Maksymovich WP, Rowe BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178(5):569–575PubMed Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russel AS, Hanley DA, Morrish DW, Maksymovich WP, Rowe BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178(5):569–575PubMed
35.
Zurück zum Zitat Brooke RH, McGlynn EA, Cleary PD (1996) Quality of health care. Part 2: measurement quality of care. N Eng J Med 335:966–969CrossRef Brooke RH, McGlynn EA, Cleary PD (1996) Quality of health care. Part 2: measurement quality of care. N Eng J Med 335:966–969CrossRef
36.
Zurück zum Zitat Bliuc D, Ong CR, Eisman JA, Center JR (2005) Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporosis Int 16(8):977–982CrossRef Bliuc D, Ong CR, Eisman JA, Center JR (2005) Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporosis Int 16(8):977–982CrossRef
37.
Zurück zum Zitat Teng GG, Warriner A, Curtis JR, Saag KG (2008) Improving quality of care in osteoporosis: opportunities and challenges. Curr Rheumatol Rep 10(2):123–130CrossRefPubMed Teng GG, Warriner A, Curtis JR, Saag KG (2008) Improving quality of care in osteoporosis: opportunities and challenges. Curr Rheumatol Rep 10(2):123–130CrossRefPubMed
Metadaten
Titel
Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial
verfasst von
N. Yuksel
S. R. Majumdar
C. Biggs
R. T. Tsuyuki
Publikationsdatum
01.03.2010
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 3/2010
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-009-0977-z

Weitere Artikel der Ausgabe 3/2010

Osteoporosis International 3/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.