Study demonstrates pharmacists ability to identify & refer patients at-risk for fractures

Results from Project ImPACT: Osteoporosis were discussed today during the Annual Meeting of the American Pharmacists Association. Published in the March/April 2004 issue of the Journal of the American Pharmacists Association the authors, Jean-Venable “Kelly” Goode, Kim Swiger, and Benjamin M. Bluml, suggest that when patients, pharmacists and physicians collaborate closely, using pharmacy-based testing to identify and refer patients who are at-risk for future fracture that breakthrough results are possible.

• 78% of Patients Unaware of their Potential Risk for Future Fracture
• 70% of Screened Patients at Moderate- or High-Risk and Referred to Primary Care and/or
• Specialty Practice Physicians for Appropriate Diagnosis and Treatment

Project ImPACT: Osteoporosis, a community pharmacy-based demonstration project of the American Pharmacists Association (APhA) Foundation, documents one of the contributions pharmacists can make to the public health agenda for health promotion and disease prevention. Project ImPACT: Osteoporosis, an observational study, was funded through a grant from Merck & Co. Inc.

Pharmacists in the study screened 532 patients to assess the potential risk for future fracture. Risk stratification was as follows: 37% high risk, 33% moderate risk, and 30% low risk. A total of 78% of these patients indicated that they had no prior knowledge of their risk for future fracture. All of the moderate and high risk patients were referred to primary care and/or specialty practice physicians for appropriate diagnosis and treatment. All patients paid $25 out of pocket for the pharmacy-based osteoporosis screening. Telephone interviews were conducted 3 to 6 months later with 305 of the patients. In the moderate- and high-risk categories 30% and 42%, respectively, made physician office visits subsequent to the screening and 24% were initiated on new osteoporosis therapy by their physician as a result.

Phase II: Monitoring and Management Results

As a result of presentations made to executives of major health plans in the Richmond market by Ukrop’s and the APhA Foundation, an agreement was reached for third-party compensation in Project ImPACT: Osteoporosis. UnitedHealthcare of the Mid-Atlantic is paying participating pharmacists for the collaborative community health management services its’ members receive and as a result, enrollment in the second phase of the project continues.

Kelly Goode, Associate Professor, Medical College of Virginia School of Pharmacy, Virginia Commonwealth University, and lead author of the paper states, “Osteoporosis is the most common bone disease in the United States, affecting more than 10 million people. An additional 34 million Americans are at increased risk for future fracture and data consistently indicates that up to 80% of at-risk patients do not even know it. Our results provide additional confirmation, with 78% of our surveyed population indicating that this was their first osteoporosis screening.”

Kim Swiger, Category Manager, Pharmacy, Ukrop’s Super Markets, Inc. and Project ImPACT: Osteoporosis Pharmacist reflected on her experience, “There was a lot of excitement at the screening events which were very busy and patients were impressed with the ultrasound technology and the ability to get this innovative service in our stores. Our pharmacists were equally enthusiastic about offering another unique and high quality community service that focused on improving health in Richmond.”

Benjamin M. Bluml, Vice President for Research, APhA Foundation, and project architect states, “The results in this phase of Project ImPACT: Osteoporosis suggest that the collaboration between patients, pharmacists and physicians using pharmacy-based testing followed by patient counseling and appropriate referral could be an effective way to address this serious health condition that affects over 44 million Americans.” Bluml goes on to say that this is critical because, “The human and economic costs for this condition are staggering; some $17 billion in direct expenditures in hospitals and nursing homes in 2001 and that annual expense is expected to triple by 2040. Project ImPACT: Osteoporosis provides a blueprint for pharmacists to implement screening services that could provide an incredibly valuable public health contribution if implemented in communities throughout the United States.”