Brief telephone intervention increases testing for osteoporosis in patients treated in emergency departments for wrist fractures

Effect of a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma non-hip fracture: a systematic review

The aim of this study was to identify the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. A dedicated osteoporosis health professional improved investigation and management of osteoporosis. Osteoporosis management was enhanced, leading to the potential for future fracture prevention.

PURPOSE

This study aimed to review the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture.

METHODS

We searched the electronic databases of Medline, EMBASE, CINAHL, Current Contents Connect, Joanna Briggs Institute EBP, and Cochrane from database development to April 2013, examined grey literature, and completed manual searches of reference lists to identify English language research that examined the effect that dedicated health professional input had on osteoporosis management with acute low trauma non-hip fracture in the outpatient setting. Outcomes were defined as the proportion of patients with investigation (bone mineral density (BMD) or blood screen); treated with vitamin D supplementation or antiresorptive agent; documented BMD reading change; recurrent fracture occurrence; or referral to specialist bone (osteoporosis) clinic.

RESULTS

All studies with a suitable control group showed an increase in BMD screening in the intervention group (odds ratio (OR) 5.4, 95% confidence interval (CI) 4.3-6.9, P<0.0001). The effect on treatment initiation showed a significantly increased rate of antiresorptive±vitamin D therapy (OR 5.3, 95% CI 4.1-6.8, P<0.0001). No studies examined improvement or decline in BMD guiding clinical practice as an outcome. Two studies showed reduced fracture recurrence. The osteoporosis health professional significantly increased referrals to a specialist bone clinic (OR 9.6, 95% CI 6.2-14.6, P<0.0001).

CONCLUSIONS

The presence of a dedicated osteoporosis health professional coordinating a targeted intervention for outpatients with low trauma non-hip fracture improves investigation and management of osteoporosis, resulting in the potential for future fracture prevention.

Closing the postfracture care gap using administrative health databases: design and implementation of a randomized controlled trial

Postfracture care is suboptimal, and strategies to address this major care gap are urgently required. Case management is effective but is resource intensive and difficult to deliver to a widely scattered population. We describe the design and successful implementation of a randomized controlled trial (NCT00594789), which uses provincial administrative health databases to notify eligible physicians and patients after a major osteoporotic fracture that such fractures warrant additional assessment or pharmacologic treatment to prevent subsequent fractures. Men and women aged 50 yr or older residing in the Province of Manitoba, Canada, with a recently reported clinical fracture (hip, spine, humerus, and forearm) from medical claims data, and without recent bone mineral density (BMD) testing (in the last 3 yr) or osteoporosis therapy (in the last year), were randomized to 3 groups: group 1 received usual care, group 2 (physicians only) had mailed notification to the primary care physicians (alert letter, BMD requisition, and management flowchart), and group 3 (physicians and patient) had both physician notifications and patient notification (alert letter). During the initial 10 mo (from June 2008 to March 2009), 2901 fracture patients meeting the inclusion criteria were randomized. Groups were well balanced. Direct costs related to the initiative (programming, case identification, and mailings) were Canadian dollars (CAD$)12,379 during the pilot phase, which translates to CAD$6.50 per notification (groups 2 and 3). Ongoing costs (which exclude the initial programming costs) are estimated at CAD$1.25 per notification. This postfracture intervention, based on medical claims data, provides an easy way to enhance postfracture care. The approach is scalable, can be delivered to a widely scattered population, and requires minimal infrastructure. This low-cost intervention may complement more resource-intensive programs based on case managers.