Impact of a pharmacist-directed intervention in postmenopausal women after fracture
- 15 March 2012
- journal article
- Published by Oxford University Press (OUP) in American Journal of Health-System Pharmacy
- Vol. 69 (6), 504-509
- https://doi.org/10.2146/ajhp110309
Abstract
Purpose The impact of decentralized clinical pharmacy services on the implementation of appropriate care in postmenopausal women with a recent history of a fracture was assessed. Methods Women 67 years of age or older with a documented fracture between January 1 and December 31, 2007, were identified in two geographic regions. At the intervention site, a decentralized clinical-pharmacy-based osteoporosis management service (CPOMS) intervened on postmenopausal women following fracture, while the comparison group utilized a centralized registered nurse to manage this population. In both groups, interventions included initiation of either osteoporosis medication or bone mineral density (BMD) screening. Results Of the 827 women in the CPOMS group, 65% (523) initiated a medication for osteoporosis or completed BMD screening within 6 months of the fracture, compared with 46% (139) of the 302 women in the comparison group (p < 0.001; cumulative incidence ratio [CIR], 1.75; 95% confidence interval [CI], 1.44–2.12). CPOMS patients were nearly twice as likely as comparison group patients to purchase osteoporotic medications (42% [347 of 827] versus 24% [73 of 302]; CIR, 1.89; 95% CI, 1.50–2.40) and equally likely to undergo BMD testing (35% [289 of 827] versus 31% [94 of 302]; CIR, 1.13; 95% CI, 0.91–1.39). Both interventions achieved results substantially higher than national averages. Of patients receiving a medication and continuous membership for 12 months, adherence was also significantly higher in the CPOMS group (46% [39 of 291] versus 28% [20 of 71], respectively; p = 0.007). Conclusion An integrated pharmacist-run osteoporosis management service demonstrated a substantial increase in the rate of osteoporosis drug initiation among post-menopausal women who experienced a fracture compared with a centrally located nurse-run service. BMD screening rates did not significantly differ between groups.Keywords
This publication has 22 references indexed in Scilit:
- Osteoporosis disease management for fragility fracture patients: New understandings based on three years' experience with an osteoporosis care serviceArthritis Care & Research, 2007
- Patient Adherence to Osteoporosis MedicationsDrugs & Aging, 2007
- Adherence to Bisphosphonate Therapy and Fracture Rates in Osteoporotic Women: Relationship to Vertebral and Nonvertebral Fractures From 2 US Claims DatabasesMayo Clinic Proceedings, 2006
- Correlates of use of antifracture therapy in older women with low bone mineral densityJournal of General Internal Medicine, 2006
- Management of osteoporosis in postmenopausal womenMenopause, 2006
- Persistence with weekly alendronate therapy among postmenopausal womenOsteoporosis International, 2006
- Outcomes of a disease-management program for patients with recent osteoporotic fractureOsteoporosis International, 2006
- Adherence, patient preference and dosing frequency: Understanding the relationshipBone, 2006
- Effect of Dosing Frequency on Bisphosphonate Medication Adherence in a Large Longitudinal Cohort of WomenMayo Clinic Proceedings, 2005
- Early discontinuation of treatment for osteoporosisAmerican Journal Of Medicine, 2003