Abstract
Purpose: To test a novel Patient Education and Physician Alerting (PEPA) intervention that seeks to improve the proportion of correct diagnosis and management of osteoporosis in older adults who have sustained a recent hip fracture secondary to a fall.
Methods: Design: Six-month randomized controlled trial. Participants were randomized either to the PEPA group (intervention) or the usual-care group (control). Participants and Setting: Forty-eight men and women aged 60 years and older who were admitted to Vancouver General Hospital for a fall-related hip fracture.|Measurements: The Diagnosis and Management Questionnaire (DMQ) was administered to all participants to determine the rate of investigation and treatment of osteoporosis. The responses were validated in part by physician report obtained for one half of the participants. Statistical Analyses: We compared the difference between the two experimental groups in the proportion of individuals who received bisphosphonate therapy within 6 months after their hip fracture using the chi-square test. The alpha level was set at P < 0.05. |
Results: To date, thirty-three of the 48 participants have completed this 6-month randomized controlled trial. Among these 33 participants, we found a significant difference between the two groups in the proportion of individuals who received bisphosphonate therapy after their hip fracture (p < 0.001). In the PEPA group, 70% (14 out of 20) were put on bisphosphonate therapy within 6 months after experiencing a fragility hip fracture. In contrast, 0% (0 out of 13) were put on bisphos-phonate therapy within 6 months after experiencing a fragility hip fracture in the usual-care group. Of the 78 individuals who were eligible for this study, 48 agreed to participate.
Conclusions: Currently, there is an established care gap for patients who sustain a fragility fracture. This cohort of individuals who fractured their hip did not receive guideline care unless recommended by the PEPA intervention letters sent to the participant delivered to the family physician. Patients who sustain a low-trauma hip fracture and are “at risk” for osteoporosis and do not receive recommended “best practice” care.
Funding : Commerical funding
Funding Parties : Aventis Pharmaceuticals
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
