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UAB Pilot Program Leads to Better Diagnosis and Treatment of Osteoporosis Among Home Health Patients

As many as 10 million Americans suffer from osteoporosis — an often symptomless disease that causes bones to become thin, fragile and more prone to unexpected, painful fractures.

While men and women of any age can develop osteoporosis, the disease affects mostly postmenopausal women and older adult men. “This disease can be devastating for older adults, and a fracture is often the first symptom” observes Meredith Kilgore, RN, PhD, associate professor of Health Care Organization and Policy at the University of Alabama at Birmingham (UAB). “Hip and spine fractures, in particular, can severely limit older adults’ mobility and infringe on their ability to maintain independence. Also, a high mortality rate is associated with fractures.”

Older Adults Missing Out on Diagnosis, Treatment

Dr. Kilgore says that while older adults are at a higher risk for osteoporosis, the disease is under diagnosed and undertreated among this group. “We know that about one-third of Medicare beneficiaries suffer fragility fractures,” he says. “Yet one-half of these individuals never receive a diagnosis of osteoporosis.”

Dr. Kilgore stresses that screening rates for the disease are also low. “Many older adults have multiple chronic conditions requiring medical care,” says Dr. Kilgore. “As a result, screening for osteoporosis sometimes doesn’t receive a great deal of attention from medical professionals.”

A Focus on the Home Health Care Setting

To address the problem of under diagnosis and treatment of osteoporosis among older adults, Dr. Kilgore and his colleagues at UAB designed an intervention program that focused on home health care patients with a history of fractures. The program was piloted among patients at an Alacare Home Health Care office in Birmingham, AL, and funded by the Center for Education and Research in Therapeutics.

“Our intervention program was aimed at improving the rates at which home health patients with a history of fractures were treated with medications, vitamin D, and calcium supplements to prevent recurrent fractures,” explains Dr. Kilgore. He says the home health care setting provided a favorable environment in which to develop a program that would incorporate a nursing care plan and a patient education program. “Home health nurses are well trusted by patients. Because they come into the home frequently, they typically also have a close relationship with patients. They have an opportunity to reinforce information and help patients adhere to treatment regimens.”

Promising Results for Better Diagnosis, Treatment

As part of the program, Dr. Kilgore and his colleagues developed a nursing care plan, programmed into an electronic medical record that was activated by home health nurses for patients with a history of fractures (identified as high risk for osteoporosis). The care plan included education materials informing patients about the risks of fractures and the availability of effective treatments, including prescription drugs, vitamin D, and calcium supplements.

In addition to patient education, the program also included continuing education for home health nurses. “We provided in service training for nurses in addition to the nursing care plan,” says Dr. Kilgore. The program also included a notification to physicians that patients were identified as at risk for osteoporosis. “Physicians received prepared order sheets with options for medications and dietary supplements as well as in-depth information on fracture risks and therapy effectiveness.”

The pilot program achieved promising results in helping to identify and treat home health patients at risk for osteoporosis. In the year prior to the pilot program intervention, only 22% of patients with fractures received medications, while 12% received supplements. After the intervention, 43% of identified fracture patients received both medications and supplements.

“We’re currently conducting a randomized trial to determine the feasibility of implementing the program at home health care offices statewide,” says Dr. Kilgore. “We believe the program has the potential to significantly improve diagnosis and treatment rates for older adults with osteoporosis in the home health care setting.”

Article last updated: December 3, 2009 10:52 AM