Abstract
Untreated osteoporosis increases the risk of fragility fractures; a major cause of morbidity and mortality worldwide. Bisphosphonates have been shown to reduce fracture risk yet can be associated with adverse side-effects . As such, their long-term use should be monitored so that maximal benefit is obtained with minimal harm to the patient. Despite this, the management of osteoporosis in primary care remains poor. The purpose of this audit was to evaluate the long-term management of patients on bisphosphonate therapy. It assessed whether individuals were placed on appropriate treatment at diagnosis, treatment reviewed at 3-5 years and repeat DEXA scanning offered to lower risk individuals at 3-5 years. Data was taken from the osteoporosis register at a local GP surgery and individuals diagnosed greater than 5 years ago were included in this study. This audit found that whilst 83% of patients were commenced on bone sparing treatment at diagnosis, 53% were not reviewed at 3-5 years. Of those in the lower risk cohort, 60% were not offered a repeat DEXA scan within 5 years of commencing treatment. Through the promotion of the latest 'National Osteoporosis Guideline Group' guidance, a 17% increase was observed in treatment reviews, with a 43% rise in the number of lower risk individuals being offered repeat DEXA scanning. The proportion of newly diagnosed patients placed on bisphosphonate therapy remained largely unchanged. In conclusion, increasing knowledge and awareness of current osteoporosis guidelines, improves the overall management of this condition.
Comments
Question
Hello Dr Lynch. Thank you for your poster displaying your quality improvement work. How do you think you could get further improvements on year 3-5 of therapy reviews? And what barriers did you have in getting primary care health care professionals (given that they are very time-pressured) to engage with your project?
Thank you so much for taking the time to review my poster and for your question. Yes time constraints and GP work load were some of the major barriers with this along with some resistance to change and limitations of coding (i.e. only patients coded with osteoporosis could be assesed, excluding the undiagnosed).
Some the suggestions that I proposed on how to improve therapy reviews were as follows:
1) when doing annual medication reviews (which all patients should be getting anyway and usually involve a telephone call), if a patient is prescribed bisphosphonates, have a look at the duration of treatment and ask yourself are they coming up to the 5 year treatment mark? If so discuss DEXA scanning with them
2) share with practice pharmacists, often they are the ones performing medication reviews
3) include the patient in their management i.e. when you start them on this treatment inform them that the ongoing need should be reviewed in 5 years, they may come back to remind you!
4)there is a QOF (government target) for osteoporosis therefore remind the GP practice particularly partners about the financial incentive for meeting osteoporosis targets
5) when you are processing discharge letters, if it mentions fractures, check their FRAX/medication review.
Happy to answer any further questions.