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Article Title

Bridging the Gap: Evaluating Osteoporosis Therapy Medication Orders Versus Pharmacotherapy Prescription Fills Following an Osteoporotic Fracture

Publication Date

4-30-2015

Keywords

osteoporosis, fracture

Abstract

Background/Aims: Pharmacotherapy following osteoporotic fracture is a primary intervention strategy to prevent future fractures. Multiple effective pharmacotherapies are available, but postfracture treatment rates remain low. Osteoporosis treatment is defined as a prescription fill for oral or injectable bisphosphonate therapy. When a physician orders treatment but the patient does not fill, there is potential to address this gap by following up at patient level. If the physician does not order treatment, then appropriate intervention might be at physician level. This poster aims to identify gaps in treatment at Group Health Cooperative, whether they occur at patient or provider level.

Methods: The Post Fracture Care Study examines factors associated with nonreceipt of care following osteoporotic fracture between 2006 and 2012 in a cohort of 5,237 women aged ≥ 55 years at fracture, with no osteoporosis pharmacotherapy in the 12 months preceding index fracture date. Information on treatment was captured from Group Health automated pharmacy data, which includes fills at Group Practice pharmacies as well as claims for fills at external pharmacies. Medication orders were considered if they occurred within 12 months on/after index fracture date. Treatment was operationalized as: a fill between 45 days prior to medication order and 45 days after order, and within 12 months after fracture date.

Results: 10.4% (543/5,237) were ordered a bisphosphonate; 12.3% (643/5,237) received treatment (filled an oral or injectable bisphosphonate); 0.8% (40/5,237) were ordered bisphosphonate but did not receive treatment; 2.7% (140/5,237) received treatment, without record of order in EMR; and 87.0% (4,554/5,237) had neither medication order nor treatment.

Discussion: The gap of women with an osteoporotic fracture who had medication order but did not receive treatment offers a group of patients to target for intervention. For patients with neither medication order nor treatment, the provider or patient might be targeted. For future analysis, consider collecting standard documentation by physician of offer to prescribe osteoporosis therapy and patient response. This may offer additional patient subgroups to target for appropriate interventions that increase treatment rates in this vulnerable population.

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