Department of Pharmacy and Clinical Sciences/Family Medicine, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC, USA.
Ann Pharmacother. 2009 Nov;43(11):1781-6. doi: 10.1345/aph.1M366. Epub 2009 Oct 13.
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.
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.
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.
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).
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.
骨质疏松症影响了超过 1000 万美国人，骨折并发症对患者和社会造成了毁灭性的影响。尽管有指南和绩效指标可用，但骨质疏松症的管理仍不尽如人意。药剂师在管理其他疾病方面发挥了关键作用，对骨质疏松症的多学科管理可能会改善患者的预后。
在家庭医学诊所设立药剂师管理的骨质疏松症服务，并评估在该服务启动前后，患者对骨质疏松症治疗指南的短期依从性。
2008 年 10 月设立了药剂师管理的骨质疏松症服务。在该服务启动前被诊断为骨质疏松症的成年人被纳入评估短期治疗指南依从性的范围，包括适当的双能 X 线吸收法（DEXA）扫描频率、药物治疗、钙和维生素 D 补充以及非药物教育。在 42 名被转诊的患者中，有 22 名符合纳入标准。进行了回顾性病历审查，患者自身为对照，评估了服务建立前后的数据。
在服务建立之前，有 8 名（36%）患者以适当的频率接受 DEXA 扫描，而在服务建立之后，有 18 名（82%）患者接受了扫描。在服务建立之前，有 7 名（32%）患者接受了适当的药物治疗，而在服务建立之后，有 17 名（77%）患者接受了药物治疗。在服务建立之前，有 9 名（41%）患者服用钙和维生素 D，而在服务建立之后，有 22 名（100%）患者服用了钙和维生素 D。在服务建立之前，这 9 名患者中有 3 名（33%）服用了适当剂量和盐形式的钙，而在服务建立之后，有 20 名（91%）患者服用了适当剂量和盐形式的钙。在服务建立之前，这 9 名患者中有 5 名（56%）患者服用了适当剂量的维生素 D，而在服务建立之后，有 21 名（95%）患者服用了适当剂量的维生素 D。在服务建立之前，没有患者有记录的非药物教育，而在服务建立之后，所有患者都有记录。所有差异均有统计学意义（p < 0.05）。
药剂师管理的骨质疏松症服务显著提高了短期指南依从性，包括适当的 DEXA 扫描频率、药物治疗、钙和维生素 D 补充以及非药物教育。
