Each year, 4 to 5 of every 100 nursing home residents suffer a hip fracture, usually due to osteoporosis which is characterized by a decrease in bone mass and density that makes bones fragile. Nursing home adherence to osteoporosis care guidelines has the potential to reduce fractures in this frail population. However, there are several barriers to adoption of guideline-recommended care, according to a recent study. The study was supported in part by the Agency for Healthcare Research and Quality through the Centers for Education and Research on Therapeutics (CERTs) initiative (HS10389) and led by Kenneth Saag, M.D., M.Sc., of the University of Alabama at Birmingham CERT.
Current guidelines recommend bone density measurement and treatment of patients at high risk of osteoporotic fractures. Treatment includes calcium and vitamin D supplementation, antiresorptive therapy (for example, bisphosphonates) for selected individuals, as well as use of fall reduction strategies and external hip protectors.
As the first step in a multi-state quality improvement initiative, Dr. Saag and his colleagues analyzed survey responses from a random national sample comprising 1,084 medical directors and directors of nursing at skilled nursing facilities about their perceptions of barriers to guideline-recommended osteoporosis care. Survey respondents strongly agreed that fractures are a problem in their facilities and that osteoporosis guidelines are useful and cost-beneficial.
At least 40 percent of survey respondents identified multiple patient health problems, reimbursement issues, length of stay, and regulatory oversight as barriers to providing osteoporosis care. Many also felt that patient reluctance to wear hip protectors was a potential barrier. Respondents did not believe that patient and family acceptance of testing and therapy, testing availability, staff time, staff self-efficacy, or concerns about bisphosphonate safety were barriers to osteoporosis care.
For more details, see "Barriers to providing osteoporosis care in skilled nursing facilities: Perceptions of medical directors and directors of nursing," by Cathleen S. Colon-Emeric, M.D., M.H.Sc., Linda Casebeer, Ph.D., Dr. Saag, and others, in the November 2004 Journal of the American Medical Directors Association 5, pp. 361-366.
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