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19-12-2011 | Bone health | Article

Physician notifications improve postfracture care


Free abstract

MedWire News: Notification of a recent fracture sent to the patient's primary-care physician improves follow-up bone mineral density (BMD) testing and treatment for osteoporosis, Canadian research shows.

This notification system "provides a relatively simple way to enhance postfracture care," write William Leslie (University of Manitoba, Canada) and colleagues in the Canadian Medical Association Journal.

The 2010 Canadian practice guidelines for osteoporosis identified a lack of follow-up in patients who had a major fracture.

The lack of BMD screening or use of pharmacological therapy to prevent future fractures was highlighted as a "care gap" that needed addressing.

The researchers therefore conducted a randomized, controlled clinical trial involving 4264 patients who recently suffered a major fracture. The patients were randomly assigned to one of three treatment groups to determine if a physician notification system would result in better patient follow-up care than current methods.

In the first group, 1480 patients were treated with usual care. In the second group 1363 patients had notifications sent directly to their primary physicians while in the third group 1421 patients had notifications sent to their home and to their primary physicians.

Among those receiving usual care, just 4% underwent BMD screening and 11% began medical therapy for osteoporosis within 12 months of the fracture.

Comparatively, among patients who had a notification of the fracture sent to the primary physician, 16.4% underwent BMD testing and 14.7% initiated pharmacologic therapy.

Notifications sent to the patient and physician did not significantly increase BMD testing or medication use when compared with the group of patients who had notifications sent to the physician only, note the researchers.

However, when they combined groups two and three, which encompassed patients who had notifications sent to their physicians, they found that 17.3% underwent BMD testing and 10.4% received medication within 12 months of the major fracture.

"This strategy is suitable for implementation on a population level and in areas where population density would not easily support a case-management strategy, providing that high-quality administrative data are available," conclude Leslie and colleagues.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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