Abstract
Background and objective: in 2003 in its publication ‘Care of fragility fracture patients’ The British Orthopaedic Association highlighted the orthopaedic surgeon’s role in assessment and management of patients at high risk from osteoporosis. In general such secondary prevention of osteoporosis is carried out poorly by orthopaedic surgeons. This audit aimed to determine if software which identifies patients at high risk from osteoporosis from clinic letters, improves orthopaedic surgeons’ referral rates for DEXA.
Methods: two audit cycles were carried out using local guidelines. The audits concerned patients over 50 years having sustained a fragility fracture of the distal radius. According to local guidelines all such patients should undergo DEXA. Patients were identified from hospital records and the number referred for DEXA determined. Those who had undergone DEXA in the year prior to fracture were excluded. The baseline audit was from April to June 2004 inclusive followed by closure of the loop between October and December 2004 following reinforcement of guidelines. Following continued poor referral rates at this point the software programme was introduced. It identifies patient age and key words in dictated clinic letters when they are being printed, for example distal radial fracture. Appropriate patients have computer generated osteoporosis advice included at the bottom of the general practitioner letter along with a DEXA referral form which General Practitioners complete. A further audit using similar methods was carried out 3 months after the software introduction (January 2006).
Results: baseline audit identified forty-three patients (36 women and 7 men) with a mean age of 73 years, 3 were referred for DEXA (7%). Following reinforcement of guidelines fifty-two patients were identified (46 women and 6 men) with a mean age of 68 years, 16 (31%) were referred. At re-audit (following the introduction of the software programme) 45 patients were identified (38 women and 7 men) with an average age of 71 years. 30 (67%) were referred for DEXA. This is a significant improvement using a Chi squared analysis.
Conclusion: the software programme significantly improves orthopaedic surgeon identification of patients at high risk of osteoporosis and referral rates for DEXA.
Correspondence should be addressed to Mr Carlos Wigderowitz, Senior Lecturer, University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY.
