Clinical guideline adherence in the primary care management of osteoporosis

Karin Doblhammer, Katharina Bergmann, Johanna Schlais, Anton Luf, Julienne Johnson, Ian Towle, Oskar Hoffmann, Stephen Hudson

Research output: Contribution to journalConference Contribution

Abstract

Background and objective To test a medication assessment tool (MAT) used for application to a database of patient records. To demonstrate its use in the evaluation of the level of adherence to osteoporosis guidelines in two practices.
Design Retrospective survey with the application of a tool specifically designed for medication assessment in this field (21 criteria, each representing a separate guideline recommendation). Setting Patients diagnosed with osteoporosis or osteopenia in records from the databases (GPASS) in two general medical practices; A (n = 154) and B (n = 62). Main outcome measures Inter-rater reliability of the tool. Percent applicability and adherence to each criterion and total adherence. Comparison of prescribing outcomes between the two practices.
Results The inter-rater reliability testing of the MAT by two independent
raters for applicability and adherence showed mean agreements of 99.1% (minimum 89.6% with 100% shown in 15/21) and 99.6% (minimum 95% with 100% shown in 18/21), respectively. In the study overall guideline adherence was 61.9% (95% CI: 59.7 and 64.1%). Comparison between the two practices showed higher adherence (P\0.0001; Fisher) in practice A than in practice B; 65.8% (95% CI: 62.3, 69.3; n = 2,926 criteria applied in 154 patients) compared with 52.1% (95% CI: 47.8 and 56.4%; n = 1,178 criteria applied in 62 patients).
Of the 200 patients with osteoporosis, 111/200 (55.5%) received bisphosphonates; 76 (38.0%) were untreated; and 19 (22.6%) received only vitamin D and calcium. Of all patients with osteoporosis alendronate was the bisphosphonate first used in 97/195 (49.7%). There were 33/200 (16.5%) secondary prevention candidates and 21/ 33 (63.6%) received a bisphosphonate. Overall only 2 patients no treated with a bisphosphonate were treated with an alternative (strontium ranelate). Conclusions The tool offers systematic and reliable audit using a database search facility to enable large scale audit of medication use in osteoporosis. The identification of an overall non-adherence of
38.1% to clinical guidelines represents a first stage in addressing pharmaceutical care issues prior to informed discussion between pharmacist prescribing advisor and general medical practitioners.

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Guideline Adherence
Osteoporosis
Diphosphonates
Primary Health Care
strontium ranelate
Databases
Guidelines
Alendronate
Vitamin D
Pharmaceutical Services
Metabolic Bone Diseases
Secondary Prevention
Pharmacists
General Practice
Calcium
General Practitioners
Testing
Outcome Assessment (Health Care)
Pharmaceutical Preparations

Keywords

  • osteoporosis
  • prescribing
  • guidelines

Cite this

Doblhammer, Karin ; Bergmann, Katharina ; Schlais, Johanna ; Luf, Anton ; Johnson, Julienne ; Towle, Ian ; Hoffmann, Oskar ; Hudson, Stephen. / Clinical guideline adherence in the primary care management of osteoporosis. In: Pharmacy World and Science. 2010 ; Vol. 32. pp. 253.
@article{9ad672dcfede4c83af952c18b965a34f,
title = "Clinical guideline adherence in the primary care management of osteoporosis",
abstract = "Background and objective To test a medication assessment tool (MAT) used for application to a database of patient records. To demonstrate its use in the evaluation of the level of adherence to osteoporosis guidelines in two practices.Design Retrospective survey with the application of a tool specifically designed for medication assessment in this field (21 criteria, each representing a separate guideline recommendation). Setting Patients diagnosed with osteoporosis or osteopenia in records from the databases (GPASS) in two general medical practices; A (n = 154) and B (n = 62). Main outcome measures Inter-rater reliability of the tool. Percent applicability and adherence to each criterion and total adherence. Comparison of prescribing outcomes between the two practices.Results The inter-rater reliability testing of the MAT by two independentraters for applicability and adherence showed mean agreements of 99.1{\%} (minimum 89.6{\%} with 100{\%} shown in 15/21) and 99.6{\%} (minimum 95{\%} with 100{\%} shown in 18/21), respectively. In the study overall guideline adherence was 61.9{\%} (95{\%} CI: 59.7 and 64.1{\%}). Comparison between the two practices showed higher adherence (P\0.0001; Fisher) in practice A than in practice B; 65.8{\%} (95{\%} CI: 62.3, 69.3; n = 2,926 criteria applied in 154 patients) compared with 52.1{\%} (95{\%} CI: 47.8 and 56.4{\%}; n = 1,178 criteria applied in 62 patients).Of the 200 patients with osteoporosis, 111/200 (55.5{\%}) received bisphosphonates; 76 (38.0{\%}) were untreated; and 19 (22.6{\%}) received only vitamin D and calcium. Of all patients with osteoporosis alendronate was the bisphosphonate first used in 97/195 (49.7{\%}). There were 33/200 (16.5{\%}) secondary prevention candidates and 21/ 33 (63.6{\%}) received a bisphosphonate. Overall only 2 patients no treated with a bisphosphonate were treated with an alternative (strontium ranelate). Conclusions The tool offers systematic and reliable audit using a database search facility to enable large scale audit of medication use in osteoporosis. The identification of an overall non-adherence of38.1{\%} to clinical guidelines represents a first stage in addressing pharmaceutical care issues prior to informed discussion between pharmacist prescribing advisor and general medical practitioners.",
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author = "Karin Doblhammer and Katharina Bergmann and Johanna Schlais and Anton Luf and Julienne Johnson and Ian Towle and Oskar Hoffmann and Stephen Hudson",
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Doblhammer, K, Bergmann, K, Schlais, J, Luf, A, Johnson, J, Towle, I, Hoffmann, O & Hudson, S 2010, 'Clinical guideline adherence in the primary care management of osteoporosis' Pharmacy World and Science, vol. 32, pp. 253. https://doi.org/10.1007/s11096-010-9378-9

Clinical guideline adherence in the primary care management of osteoporosis. / Doblhammer, Karin; Bergmann, Katharina; Schlais, Johanna; Luf, Anton; Johnson, Julienne; Towle, Ian; Hoffmann, Oskar; Hudson, Stephen.

In: Pharmacy World and Science, Vol. 32, 2010, p. 253.

Research output: Contribution to journalConference Contribution

TY - JOUR

T1 - Clinical guideline adherence in the primary care management of osteoporosis

AU - Doblhammer, Karin

AU - Bergmann, Katharina

AU - Schlais, Johanna

AU - Luf, Anton

AU - Johnson, Julienne

AU - Towle, Ian

AU - Hoffmann, Oskar

AU - Hudson, Stephen

PY - 2010

Y1 - 2010

N2 - Background and objective To test a medication assessment tool (MAT) used for application to a database of patient records. To demonstrate its use in the evaluation of the level of adherence to osteoporosis guidelines in two practices.Design Retrospective survey with the application of a tool specifically designed for medication assessment in this field (21 criteria, each representing a separate guideline recommendation). Setting Patients diagnosed with osteoporosis or osteopenia in records from the databases (GPASS) in two general medical practices; A (n = 154) and B (n = 62). Main outcome measures Inter-rater reliability of the tool. Percent applicability and adherence to each criterion and total adherence. Comparison of prescribing outcomes between the two practices.Results The inter-rater reliability testing of the MAT by two independentraters for applicability and adherence showed mean agreements of 99.1% (minimum 89.6% with 100% shown in 15/21) and 99.6% (minimum 95% with 100% shown in 18/21), respectively. In the study overall guideline adherence was 61.9% (95% CI: 59.7 and 64.1%). Comparison between the two practices showed higher adherence (P\0.0001; Fisher) in practice A than in practice B; 65.8% (95% CI: 62.3, 69.3; n = 2,926 criteria applied in 154 patients) compared with 52.1% (95% CI: 47.8 and 56.4%; n = 1,178 criteria applied in 62 patients).Of the 200 patients with osteoporosis, 111/200 (55.5%) received bisphosphonates; 76 (38.0%) were untreated; and 19 (22.6%) received only vitamin D and calcium. Of all patients with osteoporosis alendronate was the bisphosphonate first used in 97/195 (49.7%). There were 33/200 (16.5%) secondary prevention candidates and 21/ 33 (63.6%) received a bisphosphonate. Overall only 2 patients no treated with a bisphosphonate were treated with an alternative (strontium ranelate). Conclusions The tool offers systematic and reliable audit using a database search facility to enable large scale audit of medication use in osteoporosis. The identification of an overall non-adherence of38.1% to clinical guidelines represents a first stage in addressing pharmaceutical care issues prior to informed discussion between pharmacist prescribing advisor and general medical practitioners.

AB - Background and objective To test a medication assessment tool (MAT) used for application to a database of patient records. To demonstrate its use in the evaluation of the level of adherence to osteoporosis guidelines in two practices.Design Retrospective survey with the application of a tool specifically designed for medication assessment in this field (21 criteria, each representing a separate guideline recommendation). Setting Patients diagnosed with osteoporosis or osteopenia in records from the databases (GPASS) in two general medical practices; A (n = 154) and B (n = 62). Main outcome measures Inter-rater reliability of the tool. Percent applicability and adherence to each criterion and total adherence. Comparison of prescribing outcomes between the two practices.Results The inter-rater reliability testing of the MAT by two independentraters for applicability and adherence showed mean agreements of 99.1% (minimum 89.6% with 100% shown in 15/21) and 99.6% (minimum 95% with 100% shown in 18/21), respectively. In the study overall guideline adherence was 61.9% (95% CI: 59.7 and 64.1%). Comparison between the two practices showed higher adherence (P\0.0001; Fisher) in practice A than in practice B; 65.8% (95% CI: 62.3, 69.3; n = 2,926 criteria applied in 154 patients) compared with 52.1% (95% CI: 47.8 and 56.4%; n = 1,178 criteria applied in 62 patients).Of the 200 patients with osteoporosis, 111/200 (55.5%) received bisphosphonates; 76 (38.0%) were untreated; and 19 (22.6%) received only vitamin D and calcium. Of all patients with osteoporosis alendronate was the bisphosphonate first used in 97/195 (49.7%). There were 33/200 (16.5%) secondary prevention candidates and 21/ 33 (63.6%) received a bisphosphonate. Overall only 2 patients no treated with a bisphosphonate were treated with an alternative (strontium ranelate). Conclusions The tool offers systematic and reliable audit using a database search facility to enable large scale audit of medication use in osteoporosis. The identification of an overall non-adherence of38.1% to clinical guidelines represents a first stage in addressing pharmaceutical care issues prior to informed discussion between pharmacist prescribing advisor and general medical practitioners.

KW - osteoporosis

KW - prescribing

KW - guidelines

UR - http://www.gsasa.ch/formation/congres_annuels/2009_Geneve/fichiers/ESCP_GSASA_PrelimProgram.pdf

U2 - 10.1007/s11096-010-9378-9

DO - 10.1007/s11096-010-9378-9

M3 - Conference Contribution

VL - 32

SP - 253

JO - Pharmacy World and Science

T2 - Pharmacy World and Science

JF - Pharmacy World and Science

SN - 0928-1231

ER -