scholarly journals Testing the Water: Osteoporosis Management in Primary Care

Cureus ◽  
2022 ◽  
Author(s):  
Sindhuja Jothimurugan ◽  
Deepali Sanganee ◽  
Subramanian Jothimurugan ◽  
Sharmistha Williams ◽  
Myo Lynn ◽  
...  
Keyword(s):  
Primary Care ◽  
Osteoporosis Management

scholarly journals Evaluation of the Fracture Liaison Service within the Canadian Healthcare Setting

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Matthew Wong-Pack ◽  
Nawazish Naqvi ◽  
George Ioannidis ◽  
Ramy Khalil ◽  
Alexandra Papaioannou ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Primary Care Physicians ◽  
Osteoporotic Fractures ◽  
Fracture Liaison Service ◽  
Care Physician ◽  
Osteoporosis Management ◽  
Patients At Risk ◽  
Fracture Liaison ◽  
Canadian Healthcare

Previous studies evaluating fracture liaison service (FLS) programs have found them to be cost-effective, efficient, and reduce the risk of fracture. However, few studies have evaluated the clinical effectiveness of these programs. We compared the patient populations of those referred for osteoporosis management by FLS to those referred by primary care physicians (PCP), within the Canadian healthcare system in the province of Ontario. Specifically, we investigated if a referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures and if osteoporosis therapies have been previously initiated. A retrospective chart review of patients assessed by a single Ontario rheumatology practice affiliated with FLS between January 1, 2014, and December 31, 2017, was performed identifying two groups: those referred by FLS within Hamilton and those referred by their PCP for osteoporosis management. Fracture risk of each patient was determined using FRAX. A total of 573 patients (n = 225 (FLS group) and n = 227 (PCP group)) were evaluated. Between the FLS and PCP groups, there were no significant differences in the absolute 10-year risk of a major osteoporotic fracture (15.6% (SD = 10.2) vs 15.3% (SD = 10.3)) and 10-year risk of hip fracture (4.7% (SD = 8.3) vs 4.7% (SD = 6.8)), respectively. 10.7% of patients referred by FLS and 40.5% of patients referred by their PCP were on osteoporosis medication prior to fracture. Our study suggests that referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures, and clinically effective at identifying the care gap with the previous use of targeted osteoporosis therapies from referral from PCP being low and much lower in those referred by FLS. Interventional programs such as FLS can help close the treatment gap by providing appropriate care to patients that were not previously identified to be at risk for fracture by their primary care physician and initiate proper medical management.

Primary Care House Staff Attitudes Toward Osteoporosis Management

2006 ◽  
Vol 99 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Terry A. McNearney ◽  
Angela J. Shepherd ◽  
Ajoy Chhabra ◽  
Niti Goel
Keyword(s):  
Primary Care ◽  
House Staff ◽  
Staff Attitudes ◽  
Osteoporosis Management

scholarly journals MAKING OLD BONES: QUALITY IMPROVEMENT IN OSTEOPOROSIS MANAGEMENT IN A GERIATRIC PRIMARY CARE CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S975-S976
Author(s):  
Meredith Gilliam ◽  
Sabrina Vereen
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Decision Making ◽  
Quality Improvement ◽  
Fragility Fracture ◽  
Primary Care Clinic ◽  
Health Clinic ◽  
Care Clinic ◽  
Osteoporosis Screening ◽  
Osteoporosis Management

Abstract Osteoporotic fractures and their sequelae are a leading cause of morbidity and mortality in older adults. In the United States, nearly 50% of white women and 20% of black women and white men will suffer a fragility fracture in his or her lifetime. Osteoporosis medications reduce the risk of major fragility fracture by 31-62%, but numerous care gaps exist, including screening rates as low as 1-47% and treatment rates as low as 16-30% even after a fracture has already occurred. From January to August 2019, we conducted a multi-faceted quality improvement project at a university hospital-based geriatric primary care clinic, with a goal of improving our rates of osteoporosis screening and treatment. We designed and tested electronic health record-based registries of eligible patients, and developed patient outreach workflows and physician “inreach” workflows. We piloted a bone health clinic. While we did not meaningfully affect the rate of osteoporosis screening, our efforts resulted in an increase in treatment of osteoporosis from 49% to 53%. Documentation of osteoporosis decision making among eligible patients improved from 66% to 80%. In our clinic, ongoing barriers to evidence-based osteoporosis management include competition for time with other medical issues, patient mistrust of medications, and the complexity of decision making around osteoporosis in older adults with polypharmacy and limited life expectancy. Future work must balance the broad application of treatment guidelines via population health tools with the need to individualize treatment decisions for each patient’s overall health and goals of care.

Patient and Provider Characteristics Associated With Optimal Post-Fracture Osteoporosis Management

2017 ◽  
Vol 32 (6) ◽  
pp. 644-654
Author(s):  
Natalie N. Boytsov ◽  
Albert G. Crawford ◽  
Leslie Ann Hazel-Fernandez ◽  
John F. McAna ◽  
Radhika Nair ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Black Women ◽  
Predictive Models ◽  
Hispanic Women ◽  
Insurance Plan ◽  
Suburban Areas ◽  
Osteoporosis Management ◽  
Provider Characteristics

Despite an estimated 2 million osteoporosis (OP)-related fractures annually, quality of care for post-fracture OP management remains low. This study aimed to identify patient and provider characteristics associated with achieving or not achieving optimal post-fracture OP management, as defined by the current HEDIS quality measure. The study included women 67 to 85 years of age, with ≥1 fracture, and continuous enrollment in a Humana insurance plan. The study identified a higher percentage of black women in the not achieved group (6.2% vs 5.4%; P < .0001) and Hispanic women in the achieved group (3.0% vs 1.3%; P < .0001). The not achieved group largely included patients residing in the South and urban and suburban areas. The majority of providers were primary care or OP-related specialty, and 66% did not achieve the 4-star OP rating. The study findings can guide development of predictive models to identify at-risk women to improve post-fracture OP management.

scholarly journals P02 Osteoporosis management when denosumab therapy ends: an audit of current practice

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Jean Zhang ◽  
Michael A Clynes ◽  
Cyrus Cooper ◽  
Elaine M Dennison
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Alternative Therapy ◽  
Later Life ◽  
Electronic System ◽  
University Hospital ◽  
Osteoporosis Therapy ◽  
Osteoporosis Management ◽  
Other Information ◽  
Alternative Agent

Abstract Background In recent years denosumab therapy has been widely used in the treatment of osteoporosis. However, since its first introduction to clinical practice, evidence has demonstrated discontinuation leads to rebound bone loss and risk of vertebral fracture. In view of this, guidance has been updated recommending transition to an alternative osteoporosis therapy. Given that osteoporosis management is largely managed in primary care, we performed this audit to investigate whether this educational message was being effectively relayed to primary care clinicians. Methods In this study, we closed the audit loop of a previous study of the first 50 patients commenced on denosumab at University Hospital Southampton in 2013; we explored the percentage of patients remaining on denosumab 6 years later, using the hospital electronic system, which is linked to the general practice electronic system, to confirm prescriptions for osteoporosis therapy. In cases where it was unclear, letters were written, or telephone calls were made to general practices for clarification. Continuation of denosumab or use of an alternative agent was then recorded. Results Nineteen (38%) patients had died since the initial audit, reflecting the use of the agent in later life post hip fracture. Of 15 patients no longer on denosumab, 9 (60%) were found not to be on alternative bone protection without other information recorded, 1 (7%) had denosumab suspended by the GP (with the presumption it may be restarted at a later date), 1 (7%) had denosumab suspended due to recurrent cellulitis with the view to reassess in a year and 3 (20%) were on alternative therapy. One patient was recorded as being on a ‘drug holiday’. Of 16 patients remaining on denosumab, 13 (81%) had pre-injection calcium level checks, and 12 (75%) had a recorded pre-injection renal function check. Conclusion These data reflect inappropriate widespread discontinuation of denosumab without follow-on with an alternative osteoporosis therapy, suggesting that targeted education of primary care physicians is necessary. A high proportion of patients on denosumab are having the relevant blood tests in primary care as per clinical guidelines. Disclosures J. Zhang None. M.A. Clynes None. C. Cooper None. E.M. Dennison None.

scholarly journals Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0132146 ◽  
Author(s):  
Tom Chan ◽  
Simon de Lusignan ◽  
Alun Cooper ◽  
Mary Elliott
Keyword(s):  
Primary Care ◽  
Community Based ◽  
Osteoporosis Management ◽  
The Impact ◽  
Fracture Liaison ◽  
Liaison Nurse

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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