Background/Purpose: Osteoporosis is a major public health concern in the United States, leading to significant morbidity, mortality, and increased economic burden. Fractures are projected to exceed 3 million at a cost of over $25 billion by 2025. Screening for osteoporosis reduces fracture incidence. Thus, prioritizing screening is essential to lower healthcare costs and improve the quality of life for high-risk patients.

           Osteoporosis screening rates are suboptimal within the VA NEOhio Healthcare System (VANEOHS). Despite a clinical reminder to order DXA scans, primary care clinics only screen 44% of eligible female patients, compared to 90% in non-VA clinics. This quality improvement project aimed to identify barriers to osteoporosis screening throughout the VANEOHS and implement an intervention to improve the screening rate from 63% to 80% in a VA Women’s Health (WH) clinic over 1 year.

Methods: Our team, consisting of clinical pharmacists, physicians, and a Lean Six Sigma coach conducted a quality improvement study in several phases.

1. Define: we determined a system-wide screening rate by identifying female patients over 65 with a documented DXA scan or diagnosis of osteoporosis/osteopenia coded in the electronic medical record (EMR).
2. Measure and Analyze: we observed patient visits, sent a survey to 100 primary care providers regarding barriers to screening, the utility of the EMR reminder, and comfort with involving clinical pharmacists in osteoporosis care, and completed a root cause analysis (RCA) to identify areas for process improvement.  
3. Improve: we used pharmacy-driven solutions to address physician-reported barriers and tested their impact on a small scale. At a single VA Women’s Health clinic, pharmacists identified eligible patients, reviewed records, updated documentation, provided education, ordered DXAs, and scheduled follow-ups. We tracked these actions and calculated a final screening rate after 60 days.

Results:  
 

1. Define: 44% (653/1492) of eligible females in VA primary care clinics had a DXA scan completed at the VA. Of those with qualifying ICD diagnoses (351), only 244 had a DXA scan.
2. Measure and Analyze: the provider survey response rate was 20%. 50% of respondents found the EMR reminder helpful, and 50% were willing to consult pharmacists. Physician time constraints, prioritization of other conditions, and discomfort with managing osteoporosis were the most common barriers to screening, as identified in the RCA.
3. Improve: we calculated an initial screening rate of 63% based on 55 of 87 eligible patients enrolled at our intervention site with a documented DXA or qualifying ICD diagnosis. We eventually excluded 3 patients determined to be ineligible due to death, male sex, and loss of VA services. Pharmacists took over 100 actions for the remaining patients, resulting in a final screening rate of 85% (71/84).

Conclusion: Our study addressed gaps in osteoporosis care with key pharmacist-driven interventions allowing for comprehensive record review and direct patient engagement while also reducing physician workload. Our results demonstrate the impact of a multidisciplinary approach to care and the potential for this model to improve screening-based care in settings beyond the VA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-a-pharmacy-led-intervention-to-improve-osteoporosis-screening-in-va-community-based-outpatient-clinics/