Evaluation of a care pathway in the initiation of calcium and vitamin D treatment of patients after hip fracture.
Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be prescribed calcium and vitamin D at a minimum. In a retrospective chart review, we have explored the effectiveness of incorporating a standing recommendation (but not a standing order) for calcium and vitamin D treatment in a hip fracture care pathway, comparing units where the pathway had been implemented with those where it had not yet been started. The pathway resulted in significantly more initiation of calcium and vitamin D compared to patients not on the pathway (72% vs. 13.5%, p < 0.01). However, a follow-up study after four years showed a marked decline in the frequency of the initiation of calcium and vitamin D, suggesting the need for ongoing encouragement for the intervention to continue to be successful.
Faculty of Medicine, University of Western Ontario, Ontario, Canada. rcrilly@uwo.ca
Richard G
RG
Crilly
Mark
M
Speechley
Tom J
TJ
Overend
Rob
R
Mackenzie
Sylvia
S
Simon
Shirra
S
Cremer
D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000627:therapeutic use*; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D055502:Secondary Prevention; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D014807:Vitamin D