title: Brief telephone intervention increases testing for osteoporosis in patients treated in emergency departments for wrist fractures.
abstract: Previous studies show that identification and treatment of osteoporosis in patients with minimal trauma fractures treated as outpatients are poor. Our aim was to test two interventions designed to increase rates of identification and treatment. This prospective, action research study, using explicit medical record review and scripted telephone interview, was conducted at emergency departments (ED) of three hospitals from April 2007 to February 2008. Participants were patients aged over 50 years who were treated as outpatients with a minimal trauma wrist fracture. Data collected included demographic and fracture details, bone density testing and osteoporosis-related medication change. There were two interventions staff education in ED and fracture clinic and information provided to patients by telephone by a research nurse. These interventions were applied to all patients sequentially. The outcome measure of interest was the proportion of patients who underwent bone density testing (DEXA scans) in the follow-up period, analysed by intervention (clinic or phone). One hundred and seventeen patients were studied. Eighty-six per cent were female; median age 64 years. Ten per cent (12/117) of the ED/clinic intervention group had undergone testing at follow up. At follow up after the telephone intervention 55% (65/117) had undergone testing (P < 0.001, chi(2)). Patients undergoing testing were significantly more likely to have an osteoporosis-related medication change (relative risk 6.8, 95% CI 2.8-17.9). A brief telephone intervention and provision of information pack significantly improved testing rates for osteoporosis after minimal trauma wrist fracture. An ED/clinic-based intervention resulted in low rates of testing. Treatment of clinical osteoporosis remains suboptimal.
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine Hospital, Furlong Road, Melbourne, Vic. 3021, Australia. anne-maree.kelly@wh.org.au
authors.forename: A-M
authors.initials: AM
authors.lastname: Kelly
authors.forename: M
authors.initials: M
authors.lastname: Clooney
authors.forename: D
authors.initials: D
authors.lastname: Kerr
authors.forename: P R
authors.initials: PR
authors.lastname: Ebeling
mesh_terms: D000368:Aged; D003955:Diagnostic Tests, Routine / Q000639:trends; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D011885:Radius Fractures / Q000209:etiology / Q000628:therapy*; D013689:Telephone / Q000639:trends; D013997:Time Factors; D014954:Wrist Injuries / Q000209:etiology / Q000628:therapy*