Osteoporosis in the home health care setting: A window of opportunity?

Curtis, Jeffrey R.; Kim, Young; Bryant, Tara K.; Allison, Jeroan J.; Scott, Dana K.

doi:10.1002/art.22349

Cited by 11 publications

(12 citation statements)

References 75 publications

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“…In our system, patients receiving HHC services often have multiple comorbid conditions including diabetes, cardiac disease, pulmonary disease, neuro diagnoses, and open wounds; approximately 44% of patients have orthopedic diagnoses. The fact that the greater the number of comorbidities, the less likely one is to receive treatment in our study and those of others 11,14 indicates that other issues may take precedence.…”

supporting

confidence: 46%

An Opportunity for Improving Osteoporosis Treatment in Home Health Care

Switzer

Rolnick

Jackson

et al. 2010

Geriatr Orthop Surg Rehabil

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Purpose: To examine osteoporosis prevention and treatment among home health care (HHC) patients at risk of fragility fracture in a large, Midwestern integrated HHC system. Methods: All patients who received HHC services in 2006 were identified. International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes and pharmaceutical data were examined between January 1, 2004 and December 31, 2005 to determine risk status (high vs average) for fragility fracture. Patients with a documented diagnosis of osteoporosis, osteopenia, previous fragility fracture, stroke, or those taking a glucocorticoid were categorized as high risk. Pharmaceutical data (eg, estrogen, bisphosphonates) were obtained during the same 2-year period to determine treatment status. Descriptive statistics documented the proportion at high risk and treatment status. Inferential statistics tested differences in characteristics (age, gender, race, number of comorbidities) among high-risk patients with and without treatment. Results: 2798 patients were seen in HHC during 2006 and had utilization data available in 2004 and 2005. Of these, 754 were categorized as high risk and 2044 as average risk. Approximately one third (34%) of high-risk patients received osteoporosis medication compared to 4% of average risk (P < .0001). We found no treatment differences based on age. Those with higher comorbidity profiles were less likely to receive treatment (P < .0001). Conclusion: Only 34% of HHC patients at high risk for fracture received adequate treatment. Patients with more comorbidities were least likely to receive treatment. Since these individuals are receiving medical and nursing care, an opportunity exists to increase treatment rates for those at greatest risk.

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supporting

confidence: 46%

An Opportunity for Improving Osteoporosis Treatment in Home Health Care

Switzer

Rolnick

Jackson

et al. 2010

Geriatr Orthop Surg Rehabil

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“…Not only are fractures associated with a loss of mobility, but up to 22% of women and 33% of men with a hip fracture will not live a full year [2] and approximately 44% of survivors will suffer a second fracture within five years [3]. Despite guidelines from the National Osteoporosis Foundation (NOF) a to consider United States Food and Drug Administration approved medical therapies in postmenopausal women and men aged 50 years and older following a hip or vertebral fracture [4] and evidence that these therapies have been shown to decrease fracture risk in patients who have had fragility fractures [5-16], studies have shown that only 3-32% of patients receive any osteoporosis care after sustaining a hip fracture [17-21]. …”

Section: Introductionmentioning

confidence: 99%

“…Although the opportunity to intervene through home health programs appears great, few studies have focused on this setting. Through our ongoing partnership with a state-wide home health care agency admitting over 8,000 home health patients per year, we found that only 17% of persons newly enrolled in home health after discharge from a hip fracture received secondary prevention measures for osteoporosis in the form of anti-osteoporosis medications [17]. Further, other studies have documented the difficulty of increasing appropriate physician prescribing of osteoporosis medications.…”

Section: Introductionmentioning

confidence: 99%

Improving osteoporosis care in high-risk home health patients through a high-intensity intervention

Outman

Curtis

Locher

et al. 2012

Contemporary Clinical Trials

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Purpose We developed and tested a multi-modal intervention, delivered in the home health care setting, aimed at increasing osteoporosis treatment rates to prevent fractures. Material and Methods The intervention focused on home health nurses. Key components included: nursing education; development of a nursing care plan; patient teaching materials and creation of physician materials. Nursing education consisted of a lecture covering osteoporosis, fracture risks and prevention, and the effectiveness of anti-osteoporosis treatment options. Patients received education materials concerning osteoporosis and anti-osteoporosis medications. A pocket-sized treatment algorithm card and standardized order sets were prepared for physicians. Focus groups of physicians and nurses were conducted to obtain feedback on the materials and methods to facilitate effective nurse-physician communication. Successful application required nurses to identify patients with a fracture history, initiate the care plan, prompt physicians on risk status, and provide patient education. The intervention was piloted in one field office. Results In the year prior to the intervention, home health patients (n=92) with a fracture history were identified in the pilot field office and only 20 (22%) received osteoporosis prescription therapy. In the three months following the intervention, 21 newly enrolled patients were identified and 9 (43%) had received osteoporosis prescription medications. Conclusions Home health care provides a venue where patients and physicians can be informed by nurses about osteoporosis and fracture risks and, consequently, initiate appropriate therapy. This multi-modal intervention is easily transportable to other home health agencies and adaptable to other medical conditions and settings.

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“…In a final example, we evaluated home health care as an important setting to interact with post-fracture patients as the key window of opportunity[15]for osteoporosis intervention. Home health care provides services such as physical therapy, medication management or other nursing interventions.…”

Section: Bringing It All Together: Provider Patient and Systems Intmentioning

confidence: 99%

Improving osteoporosis care through multimodal interventions: insights from the University of Alabama at Birmingham Center for Education and Research on Therapeutics

Curtis

2011

Osteoporos Int

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Osteoporosis in the home health care setting: A window of opportunity?

Cited by 11 publications

References 75 publications

An Opportunity for Improving Osteoporosis Treatment in Home Health Care

An Opportunity for Improving Osteoporosis Treatment in Home Health Care

Improving osteoporosis care in high-risk home health patients through a high-intensity intervention

Improving osteoporosis care through multimodal interventions: insights from the University of Alabama at Birmingham Center for Education and Research on Therapeutics

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