Clinical guideline adherence in the primary care management of osteoporosis

Doblhammer, Karin and Bergmann, Katharina and Schlais, Johanna and Luf, Anton and Johnson, Julienne and Towle, Ian and Hoffmann, Oskar and Hudson, Stephen (2010) Clinical guideline adherence in the primary care management of osteoporosis. Pharmacy World and Science, 32. p. 253. ISSN 0928-1231 (

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Background and objective To test a medication assessment tool (MAT) used for application to a database of patient records. To demonstrate its use in the evaluation of the level of adherence to osteoporosis guidelines in two practices. Design Retrospective survey with the application of a tool specifically designed for medication assessment in this field (21 criteria, each representing a separate guideline recommendation). Setting Patients diagnosed with osteoporosis or osteopenia in records from the databases (GPASS) in two general medical practices; A (n = 154) and B (n = 62). Main outcome measures Inter-rater reliability of the tool. Percent applicability and adherence to each criterion and total adherence. Comparison of prescribing outcomes between the two practices. Results The inter-rater reliability testing of the MAT by two independent raters for applicability and adherence showed mean agreements of 99.1% (minimum 89.6% with 100% shown in 15/21) and 99.6% (minimum 95% with 100% shown in 18/21), respectively. In the study overall guideline adherence was 61.9% (95% CI: 59.7 and 64.1%). Comparison between the two practices showed higher adherence (P\0.0001; Fisher) in practice A than in practice B; 65.8% (95% CI: 62.3, 69.3; n = 2,926 criteria applied in 154 patients) compared with 52.1% (95% CI: 47.8 and 56.4%; n = 1,178 criteria applied in 62 patients). Of the 200 patients with osteoporosis, 111/200 (55.5%) received bisphosphonates; 76 (38.0%) were untreated; and 19 (22.6%) received only vitamin D and calcium. Of all patients with osteoporosis alendronate was the bisphosphonate first used in 97/195 (49.7%). There were 33/200 (16.5%) secondary prevention candidates and 21/ 33 (63.6%) received a bisphosphonate. Overall only 2 patients no treated with a bisphosphonate were treated with an alternative (strontium ranelate). Conclusions The tool offers systematic and reliable audit using a database search facility to enable large scale audit of medication use in osteoporosis. The identification of an overall non-adherence of 38.1% to clinical guidelines represents a first stage in addressing pharmaceutical care issues prior to informed discussion between pharmacist prescribing advisor and general medical practitioners.


Doblhammer, Karin, Bergmann, Katharina, Schlais, Johanna, Luf, Anton, Johnson, Julienne, Towle, Ian ORCID logoORCID:, Hoffmann, Oskar and Hudson, Stephen;