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Erschienen in: Archives of Osteoporosis 1-2/2011

01.12.2011 | Original Article

PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

verfasst von: Iouri Banakh

Erschienen in: Archives of Osteoporosis | Ausgabe 1-2/2011

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Abstract

Summary

Osteoporosis affects many people and has a large impact on health. As the condition is known to be poorly managed, a project was undertaken to improve treatment results in a hospital setting. The project succeeded in improving management of osteoporosis in patients who are admitted to hospital with broken bones.

Purpose

Osteoporosis is an inadequately managed condition around the world with high mortality and morbidity resulting from major fractures. Assessment and treatment rates for this condition are low, including hospital settings after minimal trauma fractures. The PRO-OSTEO project was set up to improve assessment and treatment rates of osteoporosis in patients admitted to Frankston Hospital’s (Peninsula Health) orthopaedic ward with minimal trauma fractures.

Method

An osteoporosis assessment and treatment algorithm was introduced into inpatient practice in March 2010. This was accompanied by a multifaceted intervention, which included posters, presentations promoting the project and one on one academic detailing to ward pharmacists, orthopaedic, endocrinology and aged care junior medical staff. Three time periods were retrospectively reviewed to determine assessment and treatment rates, before and after the introduction of the algorithm, as well as 3 months following the introduction of the algorithm, to observe the sustainability of the intervention in a new group of doctors who had not received academic detailing.

Results

Initially, the introduction of the algorithm increased treatment and assessment rates from 19.7% and 50% at baseline to 71.6% and 87.8%, respectively (p < 0.0005), with the results declining in the following period, 3 months after initial intervention and after medical/surgical staff change over, to 47.8% and 54.3%, respectively (p < 0.0005).

Conclusion

An algorithm-based approach linked with academic detailing and education of the multidisciplinary team in acute hospital environment provides a clinically significant and effective strategy to improve osteoporosis management of patients with minimal trauma fractures.
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Literatur
1.
Zurück zum Zitat Australian Institute of Health and Welfare (2011) A snapshot of osteoporosis in Australia. Australian Institute of Health and Welfare, Canberra, Arthritis series no. 15. PHE 137 Australian Institute of Health and Welfare (2011) A snapshot of osteoporosis in Australia. Australian Institute of Health and Welfare, Canberra, Arthritis series no. 15. PHE 137
2.
Zurück zum Zitat Gardner MJ, Brophy RH, Demetrakopulos D, Koob J, Hong R, Rana A et al (2005) Interventions to improve osteoporosis treamtent following hip fracture. J Bone Joint Surg (Am) 87(1):3–7CrossRef Gardner MJ, Brophy RH, Demetrakopulos D, Koob J, Hong R, Rana A et al (2005) Interventions to improve osteoporosis treamtent following hip fracture. J Bone Joint Surg (Am) 87(1):3–7CrossRef
3.
Zurück zum Zitat Mak JC, Cameron ID, March LM (2010) Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 192(1):37–41PubMed Mak JC, Cameron ID, March LM (2010) Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 192(1):37–41PubMed
4.
Zurück zum Zitat Jennings LA, Auerbach AD, Maselli J, Perkow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef Jennings LA, Auerbach AD, Maselli J, Perkow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef
5.
Zurück zum Zitat Toofanny N, Maddens ME, Voytas J, Kowalski D (2004) Low bone mass and postfall fracture risk among elderly nursing home men. J Am Med Dir Assoc 5:367–370PubMedCrossRef Toofanny N, Maddens ME, Voytas J, Kowalski D (2004) Low bone mass and postfall fracture risk among elderly nursing home men. J Am Med Dir Assoc 5:367–370PubMedCrossRef
6.
Zurück zum Zitat Rosier RN (2001) Expanding the role of the orthopaedic surgeon in the treatment of osteoporosis. Clin Orthop 385:57–67PubMedCrossRef Rosier RN (2001) Expanding the role of the orthopaedic surgeon in the treatment of osteoporosis. Clin Orthop 385:57–67PubMedCrossRef
7.
Zurück zum Zitat Casebeer L, James N (2002) Practice pattern variation in the prevention and treatment of osteoporosis. Curr Opin Rheumatol 14:453–457PubMedCrossRef Casebeer L, James N (2002) Practice pattern variation in the prevention and treatment of osteoporosis. Curr Opin Rheumatol 14:453–457PubMedCrossRef
8.
Zurück zum Zitat Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRef Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRef
9.
Zurück zum Zitat Lewiecki EM, Watts NB (2009) New guidelines for the prevention and treatment of osteoporosis. South Med J 102(2):175–179PubMedCrossRef Lewiecki EM, Watts NB (2009) New guidelines for the prevention and treatment of osteoporosis. South Med J 102(2):175–179PubMedCrossRef
10.
Zurück zum Zitat Miki RA, Oetgen ME, Kirk J, Insogna KL, Lindskog DM (2008) Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. J Bone Joint Surg (Am) 90:2346–2353CrossRef Miki RA, Oetgen ME, Kirk J, Insogna KL, Lindskog DM (2008) Orthopaedic management improves the rate of early osteoporosis treatment after hip fracture. J Bone Joint Surg (Am) 90:2346–2353CrossRef
11.
Zurück zum Zitat Teede HJ, Jaysuriya IA, Gilgillan IA (2007) Fracture prevention strategies in patients presenting to Australian hospitals with minimal-trauma fractures: a major treatment gap. Intern Med J 37:674–679PubMedCrossRef Teede HJ, Jaysuriya IA, Gilgillan IA (2007) Fracture prevention strategies in patients presenting to Australian hospitals with minimal-trauma fractures: a major treatment gap. Intern Med J 37:674–679PubMedCrossRef
12.
Zurück zum Zitat Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002) Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. MJA 176:S1–S16PubMed Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002) Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. MJA 176:S1–S16PubMed
13.
Zurück zum Zitat Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Hanley DA et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMed Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Hanley DA et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMed
14.
Zurück zum Zitat Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer KP, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalised for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer KP, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalised for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef
15.
Zurück zum Zitat Sambrook PN, Cameron ID, Chen JS et al (2011) Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study. Osteoporos Int 22:2551--2556 Sambrook PN, Cameron ID, Chen JS et al (2011) Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study. Osteoporos Int 22:2551--2556
16.
Zurück zum Zitat Soumerai SB, Majumdar S, Lipton HL (2000) Evaluating and improving physician prescribing. In: Strom BL (ed) Pharmacoepidemiology, 3rd edn. Wiley, New York, pp 483–503CrossRef Soumerai SB, Majumdar S, Lipton HL (2000) Evaluating and improving physician prescribing. In: Strom BL (ed) Pharmacoepidemiology, 3rd edn. Wiley, New York, pp 483–503CrossRef
17.
Zurück zum Zitat Andrade SE, Majumdar SR, Chan KA, Buist DSM, Go AS, Goodman M et al (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057PubMedCrossRef Andrade SE, Majumdar SR, Chan KA, Buist DSM, Go AS, Goodman M et al (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057PubMedCrossRef
18.
Zurück zum Zitat Majumdar SR, Soumerai SB (2003) Why most interventions to improve physician prescribing do not seem to work. CMAJ 169(1):30–31PubMed Majumdar SR, Soumerai SB (2003) Why most interventions to improve physician prescribing do not seem to work. CMAJ 169(1):30–31PubMed
20.
Zurück zum Zitat Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L et al (2001) Changing provider behavior. Med Care 39:II-2–II-45CrossRef Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L et al (2001) Changing provider behavior. Med Care 39:II-2–II-45CrossRef
21.
Zurück zum Zitat Prasad N, Sunderamoorthy D, Martin J, Murray JM (2006) Secondary prevention of fragility fractures: are we following the guidelines? Closing the audit loop. Ann R Coll Surg Engl 88:470–474PubMedCrossRef Prasad N, Sunderamoorthy D, Martin J, Murray JM (2006) Secondary prevention of fragility fractures: are we following the guidelines? Closing the audit loop. Ann R Coll Surg Engl 88:470–474PubMedCrossRef
22.
Zurück zum Zitat Adli M, Berghofer A, Linden M, Helmchen H, Muller-Oerlinghausen B, Mackert A (2002) Effectiveness and feasibility of a standardized stepwise drug treatment regimen algorithm for inpatients with depressive disorders: results of a 2-year observational algorithm study. J Clin Psychiatry 63:782–790PubMedCrossRef Adli M, Berghofer A, Linden M, Helmchen H, Muller-Oerlinghausen B, Mackert A (2002) Effectiveness and feasibility of a standardized stepwise drug treatment regimen algorithm for inpatients with depressive disorders: results of a 2-year observational algorithm study. J Clin Psychiatry 63:782–790PubMedCrossRef
23.
Zurück zum Zitat Bauer M, Pfennig A, Linden M, Smolka MN, Neu P, Adli M (2009) Efficacy of an algorithm-guided treatment compared with the treatment as usual. J Clin Psychopharmacol 29:327–333PubMedCrossRef Bauer M, Pfennig A, Linden M, Smolka MN, Neu P, Adli M (2009) Efficacy of an algorithm-guided treatment compared with the treatment as usual. J Clin Psychopharmacol 29:327–333PubMedCrossRef
24.
Zurück zum Zitat Polinski JM, Brookhart MA, Katz JN, Arnold M, Kristeller J, Trombetta D et al (2005) Educational outreach (academic detailing) regarding osteoporosis in primary care. Pharmacoepidemiol Drug Saf 14:843–850PubMedCrossRef Polinski JM, Brookhart MA, Katz JN, Arnold M, Kristeller J, Trombetta D et al (2005) Educational outreach (academic detailing) regarding osteoporosis in primary care. Pharmacoepidemiol Drug Saf 14:843–850PubMedCrossRef
25.
Zurück zum Zitat Shu AD-H, Stedman MR, Polinski JM, Jan SA, Patel M, Truppo C et al (2009) Adherence to osteoporosis medications after patient and physician brief education: post hoc analysis of a randomised controlled trial. Am J Manag Care 15(7):417–424PubMed Shu AD-H, Stedman MR, Polinski JM, Jan SA, Patel M, Truppo C et al (2009) Adherence to osteoporosis medications after patient and physician brief education: post hoc analysis of a randomised controlled trial. Am J Manag Care 15(7):417–424PubMed
26.
Zurück zum Zitat Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C et al (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367PubMedCrossRef Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C et al (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367PubMedCrossRef
27.
Zurück zum Zitat Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA et al (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815PubMedCrossRef Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA et al (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815PubMedCrossRef
28.
Zurück zum Zitat Wahl C, Gregoire J-P, Teo K, Beaulieu M, Labelle S, Leduc B et al (2004) Concordance, compliance and adherence in helath care: closing gaps and improving outcomes. Med Care 42(7):649–652CrossRef Wahl C, Gregoire J-P, Teo K, Beaulieu M, Labelle S, Leduc B et al (2004) Concordance, compliance and adherence in helath care: closing gaps and improving outcomes. Med Care 42(7):649–652CrossRef
Metadaten
Titel
PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study
verfasst von
Iouri Banakh
Publikationsdatum
01.12.2011
Verlag
Springer-Verlag
Erschienen in
Archives of Osteoporosis / Ausgabe 1-2/2011
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-011-0061-0

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