Pharmacist Screening for Risk of Osteoporosis in Elderly Veterans

To assess the effect of pharmacist screening for osteoporosis risk with increased bone mineral density (BMD) testing.

Prospective, quasi-experiment.

Veterans Affairs medical center Community Living Centers (CLC), home-based primary care, and outpatient geriatric clinic.

Patients with a routine pharmacist interaction were included. Exclusion criteria included hospice, dialysis, and respite care.

Risk assessment with recommendations communicated by progress notes to consider BMD testing or interventions in the settings described. A second phase of the project was conducted in CLC patients to evaluate the effect of an interdisciplinary team with the inclusion of a physician to assess clinical appropriateness of interventions.

Proportion of patients meeting guidelines for BMD testing and change in proportion of patients with BMD testing ordered after intervention. Secondary measures included response to recommendations and initiation of osteoporosis pharmacotherapies.

A total of 219 patients were included in the first phase of the project, with 120 (54.8%) identified as candidates for BMD testing with recommendations documented. Of this population, 5 patients without previous dual-energy absorptiometry results had BMD testing ordered (P = 0.6). In the second phase, 22 high-risk patients in the CLC met criteria for BMD testing, with 14 determined to have reasons for not pursuing BMD testing.

Most patients in the settings described met guidelines for BMD testing. Pharmacist recommendations to consider BMD testing did not increase the rate of testing. Including a physician on an interdisciplinary team appeared to help determine appropriateness and improve the rate of testing, though the increase in testing was not statistically significant.