Article Text

  1. K. P. Palonen1,2,
  2. C. I. Kiefe1,2
  1. 1University of Alabama at Birmingham, Birmingham, AL
  2. 2VA Quality Scholars Fellowship


Background Osteoporosis is the leading cause of fractures among postmenopausal women resulting in significant morbidity and mortality, leading Veterans Health Administration to add osteoporosis screening as a new performance indicator for 2005. We sought to evaluate the impact of a standardized template for a routine visit on osteoporosis screening and counseling for adequate calcium intake.

Methods Pre-post intervention design. Patients 65 years and older seen by participating providers at a local VA Medical Center (VAMC) women's clinic and gynecology clinic were included in the study. Pre-intervention patients were seen Aug 2002 - July 2003 and identified retrospectively using the Computerized Patient Record System (CPRS). The intervention consisted of (a) providing literature to the providers, once, on current guidelines for osteoporosis screening and adequate calcium intake (1200 mg/day) and (b) inclusion of a standardized template for routine women's clinic visit in the CPRS. Post-intervention data were collected over a six-month period following the intervention. Data abstracted from charts included past medical history and medications, evidence of osteoporosis screening with dual-energy x-ray absorbtiometry (DEXA) within a two-year period, and counseling for adequate calcium intake. Ethnicity, rates for osteoporosis screening, and counseling for calcium intake were compared using chi-square tests. Mean age and weight were evaluated using Student's t-test.

Results Pre- (N = 25) and post-intervention (N = 18) patients did not differ significantly in age (74.0, 73.3 years, p = .71), weight (167.9, 162.3 lbs, p = .66), or ethnicity (89%, 92% white, p = .73). Evidence for osteoporosis screening with DEXA increased from 44% to 89% (p = .003), and counseling for calcium intake increased from 36% to 83% (p = .002). Providers used the standardized template in 89% visits, all of which also showed up-to-date osteoporosis screening.

Conclusions Implementation of a standardized template for routine women's clinic visit improved screening rates for osteoporosis as well as counseling for adequate calcium intake at a single VAMC women's and gynecology clinics. Most women seen at VAMCs are also seen at women's clinics. As the proportion of women among veterans increases and this population ages, implementing a routine visit template may be of use in improving care for this group. Large intervention trials are not always necessary to document effectiveness.

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