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AMBULATORY CARE

Evaluation of Compliance with Osteoporosis Treatment Guidelines After Initiation of a Pharmacist-Run Osteoporosis Service at a Family Medicine Clinic

Family Medicine Pharmacy Resident, Department of Pharmacy and Clinical Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC

Sarah P Shrader, PharmD BCPS CDE

Assistant Professor, Clinical Pharmacy and Outcomes Sciences/Family Medicine, Department of Clinical Pharmacy and Outcomes Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus

Kelly R Ragucci, PharmD FCCP BCPS CDE

Associate Professor, Clinical Pharmacy and Outcomes Sciences/Family Medicine, Department of Clinical Pharmacy and Outcomes Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus

Reprints: Dr. Shrader, MUSC Family Medicine, 295 Calhoun St., Charleston, SC 29425, fax 843/792-0436, shrader{at}musc.edu

BACKGROUND: Osteoporosis affects more than 10 million Americans, and fracture complications are devastating to patients and society. Despite the availability of guidelines and performance measures, osteoporosis is not optimally managed. Pharmacists have been pivotal in management of other disease states, and a multidisciplinary approach to osteoporosis management may improve patient outcomes.

OBJECTIVE: To establish a pharmacist-run osteoporosis service at a family medicine clinic and to evaluate short-term compliance with osteoporosis treatment guidelines before and after initiation of the service.

METHODS: A pharmacist-run osteoporosis service was established in October 2008. Adults with the diagnosis of osteoporosis before initiation of the service were included in evaluation of short-term compliance with treatment guidelines, including appropriate dual-energy X-ray absorptiometry (DEXA) scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education. Of 42 referred patients, 22 were eligible for inclusion. A retrospective chart review was conducted, and patients served as their own controls, with data from before and after establishment of the service evaluated.

RESULTS: Of the 22 patients evaluated, 8 (36%) received DEXA scans at the appropriate frequency before the service was established, versus 18 (82%) after the service was initiated. Seven (32%) patients were taking appropriate pharmacotherapy before the service, versus 17 (77%) after the service. Nine (41%) patients were taking calcium and vitamin D before the service, versus 22 (100%) after the service. Three (33%) of these patients were taking the appropriate dose and salt of calcium before the service, versus 20 (91%) after the service. Five (56%) of the 9 patients were taking the appropriate vitamin D dose before the service, versus 21 (95%) after the service. No patient had documented nonpharmacologic education prior to the service, compared with all patients after the service. All differences were significant (p < 0.05).

CONCLUSIONS: A pharmacist-run osteoporosis service significantly improved short-term compliance with guidelines, including appropriate DEXA scan frequency, pharmacotherapy, calcium and vitamin D supplementation, and nonpharmacologic education.

Key Words: collaborative, guidelines, osteoporosis, pharmacy service, referral

Published Online, October 13, 2009. www.theannals.com, DOI 10.1345/aph.1M366