Overcoming barriers to secondary prevention in hip fracture patients: An electronic referral and management system for osteoporosis.
BACKGROUND
Numerous studies have shown that osteoporosis is both under diagnosed and under treated in patients with fragility fractures. We describe the use of an electronic automated referral system to enable multidisciplinary assessment and treatment of osteoporosis in patients admitted with fragility fracture of the hip.


METHODS
An electronic referral system was developed from the hospital's trauma software database. This automatically refers patients admitted with fragility fracture of the hip to osteoporosis services. Data were collected prospectively from May to July 2007, when referral was dependent on members of the orthopaedic team and from August to October 2007, after the implementation of the electronic referral system. Primary outcomes were presence of a referral to osteoporosis services, organisation of bone density scan and follow up appointment in patients less than 75 years, and treatment with osteoporosis medication in patients greater than 75 years of age.


RESULTS
There were a total of 90 patients, 47 in the non-intervention group and 43 in the intervention group. In the non-intervention group 8/47 patients (17%) were referred to osteoporosis services whilst 43/43 (100%) were referred in the intervention group. Of patients greater than 75 years, 10/32 (31.3%) were started on a bisphosphonate in the non-intervention group compared to 28/34 (82.4%) in the intervention group. Of patients less than 75 years, 1/15 (7%) in the non-intervention group had a DEXA scan booked and appropriate follow up arranged, compared to 7/9 (78%) in the intervention group. There was significant difference between both groups in all outcomes (p<0.0001).


CONCLUSIONS
We present an electronic system which facilitates delivery of osteoporosis services and significantly improves management of osteoporosis in patients admitted with fragility fracture. We recommend the use of such programmes to facilitate multidisciplinary assessment and treatment of osteoporosis in orthopaedic trauma patients.
Department of Trauma and Orthopaedics, University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom. vishalpatel@doctors.org.uk
Vishal P
VP
Patel
Rajeev
R
Mathew
Demitri
D
Raptis
Theodoros
T
Christofi
James
J
Youngman
D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D005598:Fractures, Spontaneous / Q000517:prevention & control*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation*