PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

Abstract

Osteoporosis affects many people and has a large impact on health. As the condition is known to be poorly managed, a project was undertaken to improve treatment results in a hospital setting. The project succeeded in improving management of osteoporosis in patients who are admitted to hospital with broken bones. Osteoporosis is an inadequately managed condition around the world with high mortality and morbidity resulting from major fractures. Assessment and treatment rates for this condition are low, including hospital settings after minimal trauma fractures. The PRO-OSTEO project was set up to improve assessment and treatment rates of osteoporosis in patients admitted to Frankston Hospital's (Peninsula Health) orthopaedic ward with minimal trauma fractures. An osteoporosis assessment and treatment algorithm was introduced into inpatient practice in March 2010. This was accompanied by a multifaceted intervention, which included posters, presentations promoting the project and one on one academic detailing to ward pharmacists, orthopaedic, endocrinology and aged care junior medical staff. Three time periods were retrospectively reviewed to determine assessment and treatment rates, before and after the introduction of the algorithm, as well as 3months following the introduction of the algorithm, to observe the sustainability of the intervention in a new group of doctors who had not received academic detailing. Initially, the introduction of the algorithm increased treatment and assessment rates from 19.7% and 50% at baseline to 71.6% and 87.8%, respectively (p < 0.0005), with the results declining in the following period, 3months after initial intervention and after medical/surgical staff change over, to 47.8% and 54.3%, respectively (p < 0.0005). An algorithm-based approach linked with academic detailing and education of the multidisciplinary team in acute hospital environment provides a clinically significant and effective strategy to improve osteoporosis management of patients with minimal trauma fractures.