Project IMPACT: Osteoporosis
The majority of patients participating in pharmacy-based Bone Mineral Density screenings initiated medication and lifestyle changes, including diet changes, calcium and vitamin D supplementation, and performing weight bearing exercises, Participating pharmacies received payment for both the osteoporosis screening and the collaborative health management services.
The Background
Project ImPACT: Osteoporosis is a regional health services demonstration project that expands on the care model implemented in Project ImPACT: Hyperlipidemia Project ImPACT: Osteoporosis included identification and referral of at-risk patients. Following referral, physicians diagnosed and prescribed medications as needed, and pharmacists employed the APhA Foundation process model for ongoing disease monitoring and management.
ImPACT is an acronym for Improve Persistence and Compliance with Therapy.
Key Objectives:
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To identify patients at risk for osteoporosis through community pharmacy-based bone mineral density (BMD) screening, to refer at-risk patients to primary care and/or specialty practice physicians, and to follow-up with at-risk patients
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To treat and manage osteopenic and osteoporotic patients referred to the pharmacy for medication therapy management services
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To test a payment methodology for pharmacists who deliver community health management services to a population at risk for or diagnosed with osteoporosis.
The Participants
Patients
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In Phase 1, members of the Richmond, VA community were invited to screening events at a grocery store chain. 532 patients were screened and 305 of those patients were reached for follow-up interviews 3 to 6 months later during the second phase of the project.
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In Phase 2, beneficiaries of UnitedHealthcare received ongoing maintenance and monitoring services through self-referral or physician referral.
Pharmacies
Ukrop’s Super Markets, Inc. is a regional grocery and pharmacy chain and was selected because of the project’s goal to effectively address this health issue within a geographic region. The supermarket chain was previously involved in a variety of innovative patient care services; therefore, osteoporosis screening was a natural addition to other wellness services. At the time of the project, Ukrop’s was comprised of 29 stores , with 22 pharmacy locations in the Richmond, Virginia area. In preparation for the project, pharmacists attended an Osteoporosis Certificate Training Program. Pharmacists also received education on operation of the Sahara Hologic Ultrasound Bone Densitometer. The stores and pharmacists participated in Project ImPACT: Osteoporosis through marketing, screening events, and ongoing disease management programs.
The Methods
Phase One: Health Promotion and Disease PreventionCollaboration, marketing, screening, and referral were the cornerstones of Phase 1. Collaborating physicians promoted the screening program to their patients and Ukrops placed advertisements in local newspapers and store flyers. Patients went to the pharmacy for screening events and wellness days where osteoporosis risk stratification and bone mineral density screening took place. Patients paid an average of $25 for the screening. Risk stratification was performed for ever patient and 16% of patients received a bone mineral density scan.
Education, referral and follow-up was provided to consumers based on the risk level and screening resultsfor future fracture (Figure 1). Link to Fig 1. When the patient visited with the physician based on referral, the physician made an assessment and potential diagnosis of osteopenia or osteoporosis then referred the patient back to the pharmacy for the collaborative community health management program if deemed necessary. All patients received a follow-up phone call 3 to 6 months after the screening to assess the outcome of the referral, any changes in lifestyle, and interest in Ukrop’s community health management program.
Phase Two: Implementation of Collaborative Community Health Management Services
The second phase focused partnering with a third party payer to develop an osteoporosis monitoring and management program. and the program implemented by UnitedHealthcare was available to beneficiaries who were at risk for or diagnosed with osteoporosis and live in the Richmond area. The program focused on the accessibility of pharmacists, practice resources available, benefits of aligning incentives, and utilizing Ukrop’s proven ability to deliver regional services with an ongoing commitment to improving health care in the Richmond community.
The Results
The pharmacists screened 532 patients and were able to contact 305 of these patients for follow-up interviews 3 to 6 months later.
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70% of the 532 patients screened were at high or moderate risk for future fracture
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A total of 78% of patients indicated that they had no prior knowledge of their risk for future fracture.
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29% of patients scheduled a physician visit after the screening and 19% of patients were initiated on medications for preventing and treating osteoporosis due to physician referral.
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The majority of patients participating in pharmacy-based Bone Mineral Density screenings initiated medication and lifestyle changes, including diet changes, calcium and vitamin D supplementation, and performing weight bearing exercises,
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Participating pharmacies received payment for both the osteoporosis screening and the collaborative health management services.
Read the full manuscript published in JAPhA here.