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Erschienen in: Calcified Tissue International 6/2014

01.06.2014 | Original Research

Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service

verfasst von: Richard H. Lee, Kenneth W. Lyles, Megan Pearson, Karen Barnard, Cathleen Colón-Emeric

Erschienen in: Calcified Tissue International | Ausgabe 6/2014

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Abstract

Fewer than 24 % of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients’ medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient’s primary provider with specific recommendations for further management. Recommendations were initiated at the provider’s discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1 %) consults recommended immediate bisphosphonate treatment, and 258 (58.1 %) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4 %) and by ordering bone density testing in 183 (70.9 %) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8 % for bisphosphonates and 21.3 % for calcium/vitamin D. After implementation, the treatment rate increased to 7.3 % for bisphosphonates (p = 0.02) and 35.2 % for calcium/vitamin D (p < 0.01). While feasible and relatively low-cost, an E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.
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Metadaten
Titel
Osteoporosis Screening and Treatment Among Veterans with Recent Fracture After Implementation of an Electronic Consult Service
verfasst von
Richard H. Lee
Kenneth W. Lyles
Megan Pearson
Karen Barnard
Cathleen Colón-Emeric
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
Calcified Tissue International / Ausgabe 6/2014
Print ISSN: 0171-967X
Elektronische ISSN: 1432-0827
DOI
https://doi.org/10.1007/s00223-014-9849-4

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