title: Impact of a pharmacist-directed intervention in postmenopausal women after fracture.
abstract: OBJECTIVE
  The impact of decentralized clinical pharmacy services on the implementation of appropriate care in postmenopausal women with a recent history of a fracture was assessed.
  
  
  METHODS
  Women 67 years of age or older with a documented fracture between January 1 and December 31, 2007, were identified in two geographic regions. At the intervention site, a decentralized clinical-pharmacy-based osteoporosis management service (CPOMS) intervened on postmenopausal women following fracture, while the comparison group utilized a centralized registered nurse to manage this population. In both groups, interventions included initiation of either osteoporosis medication or bone mineral density (BMD) screening.
  
  
  RESULTS
  Of the 827 women in the CPOMS group, 65% (523) initiated a medication for osteoporosis or completed BMD screening within 6 months of the fracture, compared with 46% (139) of the 302 women in the comparison group (p < 0.001; cumulative incidence ratio [CIR], 1.75; 95% confidence interval [CI], 1.44-2.12). CPOMS patients were nearly twice as likely as comparison group patients to purchase osteoporotic medications (42% [347 of 827] versus 24% [73 of 302]; CIR, 1.89; 95% CI, 1.50-2.40) and equally likely to undergo BMD testing (35% [289 of 827] versus 31% [94 of 302]; CIR, 1.13; 95% CI, 0.91-1.39). Both interventions achieved results substantially higher than national averages. Of patients receiving a medication and continuous membership for 12 months, adherence was also significantly higher in the CPOMS group (46% [39 of 291] versus 28% [20 of 71], respectively; p = 0.007).
  
  
  CONCLUSIONS
  An integrated pharmacist-run osteoporosis management service demonstrated a substantial increase in the rate of osteoporosis drug initiation among post-menopausal women who experienced a fracture compared with a centrally located nurse-run service. BMD screening rates did not significantly differ between groups.
authors.affiliation: Pharmacy Department, Kaiser Permanente Skyline Clinic, Denver, CO 80205, USA. rachel.m.heilmann@kp.org
authors.forename: Rachel M F
authors.initials: RM
authors.lastname: Heilmann
authors.forename: Cari R
authors.initials: CR
authors.lastname: Friesleben
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Billups
mesh_terms: D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D055118:Medication Adherence; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000188:drug therapy; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents