P139 The impact of identifying poor adherence to bone protective treatment via postal questionnaire - Bath Fracture Liaison Service (FLS) audit

Abstract

Abstract Background/Aims As part of the Royal United Hospitals Bath FLS, postal questionnaires assessing adherence to treatment are sent to patients (aged 50 or above) in whom we had recommended initiation of bone protective treatment (BPT) following identification of a low-trauma fracture. Upon receipt by the FLS of a completed adherence questionnaire, correspondence is sent to the GP to report the outcome, with recommendations as appropriate. The aim of this audit was to assess how many patients started (or re-started) treatment after reporting poor adherence. Methods Patients sent an adherence questionnaire in 2019 were screened for inclusion in the audit. These patients had sustained a low-trauma fracture approximately 1 year prior. For those reporting poor adherence (defined as either BPT not prescribed, or non-adherence to treatment), our hospital electronic record system (Millennium) and primary care electronic records (SystmOne) were scrutinised to assess whether BPT was subsequently initiated. Results A total of 1164 questionnaires were sent and 684 (59%) were completed and returned to the FLS. Of the questionnaires returned, 366 (54%) reported good adherence and 257 (38%) reported poor adherence. 61 (9%) of patients reported a decision not to take treatment. 88 of the 257 patients who reported poor adherence were excluded from the audit for the following reasons: 5 patients excluded because an outcome letter was inadvertently not sent to the GP and therefore these patients were not directly comparable with the other patients. 25 subsequently deceased patients were excluded because we were unable to ascertain if they had started/re-started treatment following the poor adherence letter. 51 patients were excluded because the primary care electronic record was unavailable and therefore although there was no evidence on our hospital electronic record system that treatment had been prescribed, we could not be certain that this was the case. 7 patients reported that they had not been prescribed treatment but there was evidence that treatment had been prescribed at the time of the adherence check. This provided us with a final eligible cohort of 169 patients for further analysis. We found evidence that 65 (38%) of 169 patients were prescribed or re-prescribed bone protection treatment following our poor adherence letter to the GP. Treatment was ongoing in 40 (24%) patients at the time of this analysis. Conclusion Our FLS policy of sending outcome letters to GPs following patient-reported poor adherence to BPT is partially effective in prompting prescription/re-prescription of treatment where appropriate. Our FLS will need to employ additional/alternative methods to improve our performance. Disclosure S.M. Warren: None. J.L. Webb: None. T. Ahmed: None.