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Evaluation of a Care Pathway in the Initiation of Calcium and Vitamin D Treatment of Patients after Hip Fracture

Published online by Cambridge University Press:  01 March 2009

Richard G. Crilly ,
Mark Speechley ,
Tom J. Overend ,
Rob Mackenzie ,
Sylvia Simon  and
Shirra Cremer
Richard G. Crilly*
Affiliation:
Faculty of Medicine, University of Western Ontario
Mark Speechley
Affiliation:
Department of Epidemiology & Biostatistics, University of Western Ontario
Tom J. Overend
Affiliation:
School of Physical Therapy, Elborn College, University of Western Ontario
Rob Mackenzie
Affiliation:
Geriatric Rehabilitation Unit, Parkwood Hospital, London, ON
Sylvia Simon
Affiliation:
London Health Services Center, University Hospital, London, ON
Shirra Cremer
Affiliation:
Department of Epidemiology & Biostatistics, University of Western Ontario
*
*Request for offprints should be sent to:Dr. Richard Crilly Division of Geriatric Medicine, Parkwood Hospital 801 Commissioners Road East London, Ontario, Canada N6C 5J1 Telephone: 519-685-4021 E-mail: [email protected]
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Abstract

Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be prescribed calcium and vitamin D at a minimum. In a retrospective chart review, we have explored the effectiveness of incorporating a standing recommendation (but not a standing order) for calcium and vitamin D treatment in a hip fracture care pathway, comparing units where the pathway had been implemented with those where it had not yet been started. The pathway resulted in significantly more initiation of calcium and vitamin D compared to patients not on the pathway (72% vs. 13.5%, p < 0.01). However, a follow-up study after four years showed a marked decline in the frequency of the initiation of calcium and vitamin D, suggesting the need for ongoing encouragement for the intervention to continue to be successful.

Résumé

Les fractures de la hanche sont des fractures de fragilité, et la présence de ce type de fractures augmente les risques d'en subir d'autres. Bien que la manière de définir l'ostéoporose, qui requière des traitements antirésorption, chez les patients qui ont subi une fracture de la hanche n'est pas très claire, ces derniers devraient minimalement se faire prescrire du calcium et de la vitamine D. Lors d'un examen rétrospectif des dossiers, nous avons étudié l'efficacité d'inclure une recommandation (et non un règlement) sur la prise de calcium et de vitamine D au plan d'intervention concernant les fractures de la hanche, en comparant les unités où cette façon de faire a été implantée avec celles qui ne l'ont pas encore mise en place. Il résulte de ce plan d'intervention un nombre plus important de prescriptions de calcium et de vitamine D comparativement aux unités qui ne suivent pas ce plan (72% contre 13,5% ; p<0,01). Cependant, une étude prospective a démontré après quatre ans un déclin marqué dans la fréquence des prescriptions de calcium et de vitamine D. Cela suggère la nécessité d'un encouragement constant pour que les interventions continuent d'obtenir du succès.

Keywords

vieillissementfracture de la hancheplan d'interventionévaluationcalciumvitamine Daginghip fracturecare pathwayevaluationcalciumvitamin D
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 28 , Issue 1 , March 2009 , pp. 21 - 26
Copyright
Copyright © Canadian Association on Gerontology 2009

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