Testing shows women unaware of fracture risk

Project shows collaboration across continuum

Pharmacists in a recent project screened and counseled patients about their risk for bone fractures — and found that most of them (78%) had no knowledge of their risk prior to the screening.

Results of Project ImPACT: Osteoporosis suggest that "breakthrough" results are possible when patients, pharmacists, and physicians collaborate closely, using pharmacy-based testing to identify and refer patients who are at-risk, the project researchers say. Although the project involved community pharmacy-based testing, it has ramifications for hospital pharmacists who work with their patients on medication management and overall disease prevention.

"Pharmacists have a huge role in prevention activities," says Jean-Venable "Kelly" R. Goode, PharmD, BCPS, an associate professor at the Medical College of Virginia School of Pharmacy, Virginia Commonwealth University, in Richmond. She is the lead author of the paper that detailed the results of the study. The paper recently was published in the March/April 2004 issue of the Journal of the American Pharmacists Association.

"So many times we just respond to patients’ drug treatment, when we can also look at their current medications and see the risks that they may have for other diseases," she says. For example, people who are on chronic steroids are at risk for osteoporosis. "We can counsel those patients so we can maybe prevent them having that problem in the future."

Project ImPACT: Osteoporosis is a demonstration project of the American Pharmacists Association (APhA) Foundation. The observational study was funded through a grant from Merck & Co.

The project was conducted in a regional supermarket chain in Virginia. Much of the project was held during Women’s Health Month, Goode says. The project was promoted with in-store signs, shelf-talkers, and messages on grocery store receipts.

Project ImPACT: Osteoporosis had two phases. One focused on screening, patient education, and referral at key sites. The screening was not diagnostic, Goode says. Instead it looked at risk of future fracture. All patients paid $25 out-of-pocket for the pharmacy-based screening. 

The project screened a total of 532 patients for osteoporosis between May 2001 and October 2002. Most of the patients were women (93%), with a mean age of 55.8 years. The risk stratification was 37% high risk, 33% moderate risk, and 30% low risk. All of the moderate and high-risk patients were referred to primary care and/or specialty practice physicians for appropriate diagnosis and treatment. 

"One of the great things about being screened early for osteoporosis is that patients can start doing some preventive measures," Goode says. Based on the risk for future fracture, a pharmacist can appropriately counsel patients on the things they need to do to prevent osteoporosis, such as taking calcium and vitamin D supplements, doing weight-bearing exercises, and limiting caffeine and alcohol intake. Patients in a high- or moderate-risk category can be referred to their physician for diagnostic testing.

Opening the dialogue between physician and patient is a key component of preventing osteoporosis, Goode says. "Physicians have so much on their plate. They are [usually] looking at a primary problem during the visit. They don’t always have the time to look at prevention activities."

The researchers also followed-up with more than half of the patients (305) through telephone interviews three to six months later. In the moderate- and high-risk categories, 30% and 42%, respectively, made physician office visits subsequent to the screening, and their physicians initiated 24% of these patients on new osteoporosis therapy.

The second phase of the study involves rollout of both screening and collaborative community health services for patients at risk for or with osteoporosis throughout the supermarket’s customer service area. As part of this phase, the health plan UnitedHealthcare of the Mid-Atlantic is paying participating pharmacists for the collaborative community health management services provided to its members enrolled in this project.

The data from this project can help pharmacists realize they can make an impact on health-promotion activities, Goode says. "There are a lot of different things that pharmacists can become involved in for health promotion, osteoporosis being one of them. We can identify people at risk and refer them to their physicians for follow-up care. "We have a huge chronic disease burden in this country," she continues. "Many of those chronic diseases could potentially be prevented if people [took the preventive measures] earlier in life."