Multifaceted guideline implementation strategies improve early identification and management of osteoporosis

Abstract

Background: Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure. Objective: To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team?s approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis. Methods: This paper describes the implementation of multifaceted strategies to improve healthpromoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies. Results: There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care. Conclusion: This study highlights that appropriate and targeted intervention strategies can be effective if modelled on best practice guideline implementation approaches with the use of a coordinated post-fracture management approach to osteoporosis.