Abstract
Introduction:
Parkinson's disease (PD) is associated with an increased risk of osteoporosis and fractures to factors like falls resulting from postural instability, polypharmacy, and muscle weakness. Reduced bone mineral density (BMD), often caused by vitamin D deficiency, disease severity, and low BMI, further elevates fracture risk in PD patients. This project aims to improve awareness and bone health testing in PD patients by focusing on vitamin D, bone profile assessments, DEXA scans, and FRAX scores for fracture risk evaluation and management.
Methodology:
This QIP involved two cycles focused on managing Parkinson’s disease (PD) patients. The first cycle interventions focused on educating doctors through sessions and a poster, while the second cycle introduced personalized treatment plans for PD patients, recorded in their clinical notes. A comparative analysis of post-intervention data was conducted to evaluate the effectiveness of both interventions.
Results:
Bone profile testing was successfully completed in 100% of patients after both interventions. In cycle 1, 63.3% of patients required vitamin D testing, compared to 25% in cycle 2. Of these, 14.3% received testing after the first intervention, and 100% after the second. However, none of the patients had their FRAX scores calculated or DEXA scans scheduled. The teaching session increased overall confidance amongst junior doctors in diagnosing osteoporosis from 60% to 70%, and managing osteoporosis from 10% to 80%. It also improved the overall awareness on how to use the FRAX tool from around 50% to 90%.
Conclusion:
Personalized treatment plans and targeted interventions led to significant improvements in vitamin D testing. However, notable gaps remain in adherence to FRAX calculation and organizing DEXA scans. Future efforts should focus on these limitations and ensuring complete bone health assessments for PD patients. The teaching sessions proved to be highly effective, significantly enhancing participants' understanding of bone health issues in Parkinson's disease.
Comments
Very interesting. Have you considered the role of your electronic notes system in improving FRAX calculation rates (you may not use electronic notes at your hospital not sure!). Potentially the use of popups when a patient is coded to have a 'fracture' or 'fall' or 'frailty' might be useful to prompt clinicians to calculate a FRAX score and consider early bone health medication prescription :)
Good afternoon,
Thank you for your question and suggestions.
I agree that we need a more efficient method to identify patients requiring bone protection.
This is something we highlighted in our QIP report for the hospital’s Quality Improvement Forum. The idea of "pop-up" alerts is promising, as they draw focused attention to specific messages.
One of our interventions included reviewing the electronic clinical notes of patients with Parkinson's Disease (PD) and recommending that the primary team calculate FRAX scores and take appropriate action.
Other interventions, such as requesting blood tests for bone profile and vitamin D levels, were well-received, though unfortunately, we did not observe any recorded FRAX calculations. Possible reasons could include calculation errors, documentation oversights, the time-intensive nature of FRAX, or the need to prioritize acute issues.
In conclusion, there remains substantial room for improvement in clinical practice regarding bone protection, particularly for high-risk patients like those with Parkinson's Disease.
Thank you for your interest in our poster!