title: Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008.
abstract: BACKGROUND
  Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures.
  
  
  OBJECTIVE
  To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region.
  
  
  METHODS
  We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James's Hospital, Dublin.
  
  
  RESULTS
  The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers.
  
  
  CONCLUSIONS
  The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co Leitrim, Ireland, mcgowab@tcd.ie.
authors.forename: B
authors.initials: B
authors.lastname: McGowan
authors.forename: K
authors.initials: K
authors.lastname: Bennett
authors.forename: M C
authors.initials: MC
authors.lastname: Casey
authors.forename: J
authors.initials: J
authors.lastname: Doherty
authors.forename: C
authors.initials: C
authors.lastname: Silke
authors.forename: B
authors.initials: B
authors.lastname: Whelan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D017723:Drug Utilization Review / Q000639:trends; D057286:Electronic Health Records; D005260:Female; D006751:Hospital Information Systems; D006780:Hospitals, Rural; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007494:Ireland; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000188:drug therapy* / Q000209:etiology; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents