Mountjoy Cary R, Shrader Sarah P, Ragucci Kelly R
Medical University of South Carolina/South Carolina College of Pharmacy, Charleston, SC 29425, USA.
Ann Pharmacother. 2009 Feb;43(2):242-50. doi: 10.1345/aph.1L464. Epub 2009 Feb 5.
Osteoporosis continues to be poorly managed despite compelling statistics indicating increased morbidity and mortality associated with fractures. Guideline compliance in individual practices must be evaluated to implement improvements in the care of patients with this disease state.
To evaluate compliance with osteoporosis treatment guidelines by physicians and patients at 2 family medicine clinics affiliated with a large university teaching hospital.
Postmenopausal women 65 years of age or older with the ICD-9 diagnosis code 733.0 for osteoporosis during the study period between July 2006 and July 2007 were identified through the family medicine electronic medical record (EMR). Of 133 patients, 113 were eligible for inclusion. A retrospective chart review was conducted and prospective voluntary telephone surveys were administered. The EMR of each eligible patient was examined for presence of a baseline dual-energy X-ray absorptiometry (DXA) scan as well as appropriate follow-up DXA monitoring, appropriateness of osteoporosis pharmacotherapy, calcium and vitamin D supplementation, and fracture history. The telephone survey was used to assess the patients' calcium use, nonpharmacologic recommendations received, and fracture incidence after diagnosis of osteoporosis.
Of 113 patients diagnosed with osteoporosis, 68 of 82 (82.9%) had appropriate baseline DXA scans; however, only 9 (13.2%) of these 68 patients had appropriate follow-up scans every 2 years thereafter. Sixty-five (57.5%) patients were on Food and Drug Administration-approved, guideline-endorsed pharmacotherapy for osteoporosis. Thirty-five (70%) of the 50 participants in the telephone survey reported taking calcium regularly, and 41 (82%) patients recalled receiving some nonpharmacologic advice. Thirteen (26%) patients reported a fracture after diagnosis.
Osteoporosis care can be measurably improved at these clinics with use of baseline and appropriate follow-up DXA scans, increasing the number of patients who receive pharmacotherapy, and providing ongoing reinforcement of nonpharmacologic measures whereby bone health may be maintained.
尽管有令人信服的数据表明骨折相关的发病率和死亡率有所增加，但骨质疏松症的管理仍然不善。必须评估个体医疗实践中的指南依从性，以改善对患有这种疾病状态患者的护理。
评估一所大型大学教学医院附属的两家家庭医学诊所的医生和患者对骨质疏松症治疗指南的依从性。
通过家庭医学电子病历（EMR）识别出在2006年7月至2007年7月研究期间患有ICD-9诊断代码733.0的骨质疏松症的65岁及以上绝经后女性。在133名患者中，113名符合纳入条件。进行了回顾性病历审查并开展了前瞻性自愿电话调查。检查了每位符合条件患者的EMR，以确定是否存在基线双能X线吸收法（DXA）扫描以及适当的后续DXA监测、骨质疏松症药物治疗的适当性、钙和维生素D补充情况以及骨折病史。电话调查用于评估患者的钙使用情况、收到的非药物建议以及骨质疏松症诊断后的骨折发生率。
在113名被诊断患有骨质疏松症的患者中，82名患者中的68名（82.9%）进行了适当的基线DXA扫描；然而，这68名患者中只有9名（13.2%）此后每2年进行了适当的后续扫描。65名（57.5%）患者接受了美国食品药品监督管理局批准、指南认可的骨质疏松症药物治疗。电话调查的50名参与者中有35名（70%）报告定期服用钙，41名（82%）患者回忆收到了一些非药物建议。13名（26%）患者报告在诊断后发生了骨折。
通过使用基线和适当的后续DXA扫描、增加接受药物治疗的患者数量以及持续加强非药物措施，从而维持骨骼健康，这些诊所的骨质疏松症护理可以得到显著改善。
