INTRAVENOUS OSTEOPOROSIS MEDICATION ADHERENCE

Non-adherence to osteoporosis medications can be as high as 50%. Increasing medication adherence rates to osteoporosis drugs can ultimately reduce fragility fracture rates and decrease the financial and quality of life burdens that ensue. In 2012, specialized nurse practitioners from a southern California ambulatory care clinic of a large health care maintenance organization began ordering an annual intravenous osteoporosis medication in an attempt to increase adherence. However, there was no consistent reminder system to ensure that patients prescribed the drug were aware when subsequent doses were due. Following a literature review, a quality improvement project began to systematize patient reminders. An electronic reminder that was already embedded in the current electronic medical record system led to the nurse practitioners using the “Remind Me” function to notify the prescriber the subsequent dose of medication was due. At the time of the patient encounter when documenting in the medical record, an electronic reminder can be sent to the nurse practitioners that will be received 1 year later. The patient can then be notified that laboratory exams are due prior to the next medication infusion. In the previous 4 years (baseline), 277 patients received the drug zoledronic acid. Of these, 227 were females; 50 were males. The majority was between 61-89 years old. Most were Caucasian (68%); 40% had already sustained a fragility fracture. With the reminder system, the number of patients who had the osteoporosis medication ordered by nurse practitioners increased from 21% (years 2011-2013) to 54% iv in 2014 (p < .001). The reminder function had been instituted in 91% of 2014 cases. There was a moderate positive correlation noted for patients who received a second infusion; they were more likely to have a third infusion (r = .532, n = 48, p < .001). The use of the reminder system is continuing to be used when nurse practitioners order the drug. It creates a more efficient mechanism than written reminders or going through lists. The reminder is sent to all nurse practitioners, and they collaborate in communicating with the patients. The use of an electronic reminder system such as the one implemented can help to address forgetfulness, which is one of the leading causes of medication non-adherence. Nurse practitioners need to be a continued presence in investigating issues related to medication non-adherence and in developing mechanisms to assist patients in remembering to take their medications.