Pharmacist Counseling Improves Osteoporosis Medication Initiation

Postmenopausal women are more likely to start medication therapy following osteoporotic fractures if they receive counseling from a pharmacist, a study suggests.

A pharmacist-run management service in a hospital setting significantly increased the rate of osteoporosis drug initiation by postmenopausal women who had experienced fractures, according to the results of a study published in the March 15, 2012, edition of the American Journal of Health-System Pharmacy. Pharmacist counseling was particularly effective in initiating drug therapy for participants whose bone mineral density scans indicated osteoporosis, researchers reported.

The study followed women aged 67 or older who were covered by Medicare and treated for fractures at the Kaiser Permanente Skyline Clinic in Denver, Colorado, that were determined to be related to osteoporosis or pre-osteoporosis. (None of the women in the study had been previously diagnosed with or treated for osteoporosis.) The researchers split the participants into a group of 827 women who received intervention from clinical pharmacists and a group of 302 women who received intervention from a centralized registered nurse.

In the pharmacist-led group, a clinical pharmacy specialist distributed a clinic-specific report and tracked interventions to ascertain care consistency. After reviewing a participant’s medical record, the specialists created a therapeutic plan including screening recommendations, medication therapy initiation and supplementation with calcium or vitamin D if necessary. Once the recommendations were approved by a primary care physician, clinical pharmacy specialists contacted participants to initiate the plan and followed up monthly by email, telephone, or postal mail for 6 months to ensure adherence.

In the registered nurse—led group, a single centrally located registered nurse reviewed medical records for all women in the group each month. The nurse assessed the necessity of bone mineral density screening or medication therapy and sent recommendations to the primary care provider. Once the recommendations were approved, the nurse implemented the plan by telephone.

The researchers found significant differences in rates of treatment for the 2 groups. In the pharmacy management group, 65% of participants initiated medication therapy or had a bone mineral density screening in the 6 months following their fracture, compared with just 46% of those in the nurse-led group. Participants in the pharmacist-led group were also twice as likely to fill prescriptions for osteoporosis medications as were those in the nurse-led group. In particular, 81% of participants in the pharmacist-counseled group whose bone mineral density scores indicated osteoporosis (as opposed to pre-osteoporosis) began medication within 60 days of their fracture, compared with 59% of patients in the nurse-counseled group. The researchers noted that the type of medication prescribed did not vary between the 2 groups, and bisphosphonates were the most commonly prescribed class of drug in both.

In a follow-up 1 year after the fracture date, the authors assessed 291 participants from the pharmacist group and 71 women from the nurse group. They found that 46% of those who had received pharmacist counseling were adherent to their medication, compared with 28% of those who received nurse counseling. Medication persistence, however, was relatively consistent between the two groups, the researchers found.