PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

Abstract

An algorithm-based approach linked with academic detailing and education of the multidisciplinary team in acute hospital environment provides a clinically significant and effective strategy to improve osteoporosis management of patients with minimal trauma fractures.

PRO‐OSTEO Extend I study (improving osteoporosis management in the acute and rehabilitation settings): multicentre audit

“…Firstly, the study was undertaken in a single health network covering three rehabilitation sites and two acute hospitals with a wide variety of medical and surgical practices, but located within one area of one Australian state. However, population of PRO‐OSTEO Extend I was similar to populations described in other osteoporosis studies . The rates of pre‐existing minimal‐trauma fractures without any therapy initiated in primary care or during hospitalisation were similar to regional NSW population described in a study from 5 years ago .…”

“…In 2010, an academic detailing and algorithm‐based approach, the PRO‐OSTEO project, was trialled at Peninsula Health's orthopaedic ward. This pilot study demonstrated highly improved assessment and treatment rates, in accordance with current guidelines . However, subsequent audits have shown that sustainability of the project results have been a challenge, with a decline in both assessment and treatment rates observed in association with the loss of an osteoporosis nurse position, and the orthopaedic team's lack of familiarity with secondary prophylaxis and non‐surgical management of the condition.…”

“…A study published in 2007 showed that in Australian hospitals 10% of patients admitted with a minimal‐trauma fracture were assessed and 12% of these were treated for osteoporosis after assessment . In 2010, Peninsula Health's orthopaedic ward was found to have an assessment rate of 50% and an in‐hospital treatment rate of 19.7% before the academic detailing and algorithm‐based trial of the pilot PRO‐OSTEO project, which subsequently increased the rates of assessment to 87.8% and treatment to 71.6% . The results of the current study suggest that the effects of the intervention are not independently durable, and that continuous academic detailing of medical, surgical and pharmacy staff is required to maintain high results.…”

“…An application of this approach has been undertaken in South Australia, and is the only published approach of an early in‐hospital initiation of appropriate assessment and treatment of osteoporosis that has been successfully implemented and maintained over a prolonged period with the support of the primary orthopaedic team . The sub‐optimal approach from the primary teams at Peninsula Health may have greatly contributed to the results seen in this extended study, but the loss of the specialised osteoporosis nurse (who in the previous pilot study contributed to nearly 50% of all osteoporosis assessments) also had an impact.…”

“…Despite numerous campaigns by professional bodies to change the currently low rates of assessment, treatment, overall awareness of the condition and high rates of morbidity and mortality, osteoporosis remains a highly neglected disease in hospital and community settings. [1][2][3] Various approaches have been advocated, with the fracture liaison service approach being embraced despite a large proportion of patients failing to realise full benefit (mostly through non-attendance at outpatient clinics): it has been estimated that 30-50% of patients do not receive appropriate care. [4][5][6][7] Another approach to the problem is for hospital teams to provide direct and holistic treatment with secondary prevention.…”