Postfracture care improves with physician notifications

A simple physician notification system was found to help prevent further fractures in osteoporotic patients who had already had fractures, according to results of a randomized trial published in the Canadian Medical Association Journal.

“Creative strategies are needed to enhance postfracture care, which remains suboptimal,” William Leslie, MD, of the University of Manitoba, Canada, and colleagues wrote in their study, described in a recent press release.

As noted in the release, patients who suffer a major osteoporosis-related fracture do not undergo testing for bone mineral density (BMD) or receive appropriate medications to prevent further fractures — a “care gap” that puts these individuals at greater risk of additional fractures, a problem identified in 2010 Canadian clinical practice guidelines.

To study this area, researchers enrolled in their randomized controlled trial 4,264 individuals aged 50 years or older who had a major fracture (33% men; 67% women) with the goal of determining if physician notifications would result in better after care.

Leslie and colleagues randomized the participants into three groups. The first group received usual care (1,480 patients); the second group had notifications about their fracture mailed to their primary physicians (1,363); and the third group received notifications along with their physicians (1,421). They excluded from the study anyone already taking osteoporosis medication or who underwent BMD testing within 3 years after the fracture.

Leslie and colleagues reported that in the usual care group, eventually 4% of patients underwent BMD testing and 11% of patients began pharmacologic treatment for osteoporosis, according to the release.

“The low rates of postfracture intervention in the group receiving usual care, particularly among men, highlight the scale of the gap in care,” Leslie and co-authors wrote in the study. “This strategy is suitable for implementation on a population level and in areas where population density would not easily support a case-management strategy, providing that high-quality administrative data are available.”

They found that both groups in which the physician was notified showed a combined increase over usual care of 13% for BMD testing and a 5% increase in beginning pharmacologic osteoporosis treatment. However, according to the release, although the mailed notification system to physicians improves care, “additional strategies, possibly used in combination, may be more successful but need to be developed and tested. Future research should attempt to identify postfracture interventions that lead to appropriate guidelines-based care and translate into a reduction of recurrent fractures,” Leslie and colleagues concluded.

Reference:

Leslie WD, Labine L, Klassen P, er al Closing the gap in postfracture care at the population level: a randomized controlled trial. CMAJ. 2011; Dec 19. [Epub ahead of print].