Background: Acute osteoporotic hip fractures are a major and increasing burden in Australia and confer a high risk for further fragility fractures. Despite recommendations from the Australian Hip Fracture Care Clinical Care Standard, the rate of administration of antiresorptive therapy (ART) prior to discharge from hospital remains poor, leaving ongoing opportunity for strategies to improve care.
Objectives: To examine whether targeted education would result in higher rates of administration of ART in patients admitted to rehabilitation units following an osteoporotic hip fracture.
Methods: An audit of patients with an osteoporotic hip fracture discharged from rehabilitation units at Eastern Health between October 2018 and May 2019 inclusive was conducted. An educational session encouraging administration of ART prior to discharge as per the Australian Hip Fracture Care Clinical Care Standard was provided to the rehabilitation team in March 2019. Rates of consideration and administration of ART were compared before and after the intervention.
Results: 133 cases of osteoporotic hip fracture were identified, including 99 in the pre-intervention period and 34 thereafter. In the pre-intervention period, ART was considered in 55 patients (55.6%) and 35 patients (35.3%) continued or received treatment prior to discharge. In the first two months after the educational intervention, there was no demonstrable improvement in the number of patients considered for or being the recipient of ART, with 18 patients considered for treatment (OR 0.9, p=0.79) and 7 patients receiving or continuing treatment (OR 0.47, p=0.11). Documented reasons for not receiving ART included vitamin D deficiency, deferral of treatment decisions until outpatient review and patients declining treatment.
Conclusion: Interim analysis of this ongoing project did not demonstrate improvement in rates of administration of ART post-hip fracture after implementation of a brief educational intervention. Understanding the factors that contribute to patients not receiving treatment will identify targets for future interventions.