Shared learning database

Marple Cottage Surgery
Published date:
July 2008

A project to improve the screening of patients for osteoporosis and the detection of patients where intervention is appropriate by using a screening questionnaire.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To improve the screening of patients for osteoporosis and the detection of patients where intervention is appropriate by using a screening questionnaire. The WHO has established diagnostic criteria for osteoporosis based on bone mineral density scores and the treatment pathways are clear (2008, NICE, DH). However, there remains the problem of identifying patients who are at risk of osteoporosis and this project proposal addresses this.
This project has developed an osteoporosis screening questionnaire for clinicians to use in their daily consultations with primary care patients. Furthermore this projects allows patients to complete an on-line questionnaire on the practice website and send it to a clinician for assessment and appropriate follow up. We will also send this questionnaire to patients (aged over 50 years)when we recieve information from the hospital fracture clinics that one of our patients has sustained a fracture.
1. Detection of osteoporosis in patients that are not currently screened
2. Developing this service on-line on the practice website to reach a wider audience and target patients who may not attend the surgery regularly but use the website
3. Develop a clear practice care pathway for those patients who are identified as at risk following the use of the screening questionnaire

Reasons for implementing your project

We noticed a number of patients that had osteoporosis following fractures and who had symptoms of the disease but had never been screened. Addtionally there were patients who had asked for screening who were found to have significant disease when scanned, but had never been offered screening in the past. We felt that there were gaps in our screening protocol and we were missing some patients until they presented with significant morbidity caused by osteoporosis.

How did you implement the project

1. We have a structured screening questionnaire for screening assessments 2. Patients can fill in the questionnaire by asking for a paper copy, or completing an on-line version and a clinicain will evaluate it. 3. Clinicians had a robust tool to help in their clinical judgment about who to screen, thus using resources appropriately. 4. Patients diagnosed with osteoporosis and patients at risk are treated in line with local and national guidelines. 5. There is now a structured and robust system for following up patients over the age of 50 years who have sustained a fracture. Also we have a mechanism to identify patients who do not get followed up. 6. There has been greater awareness of screening, diagnosis and treatment of the condition by all members of our general practice

Key findings

The project has just begun, however, we will evaluate through the audit process every 3 months the use of the questionnaire and the outcomes. We will strive to improve this service as we learn from it.

Key learning points

We currently have several on-line questionnaire services that are very popular with out population of all ages. Patients are able to complete an asthma on-line questionnaire for example and communicate with our asthma specialist nurse or a doctor. We transferred this idea to osteoporosis screening because it allows patients to be involved and to contribute to their health and wellbeing and we felt it would be successful. In our organisation we try to work with our busy population in creative and new ways to achieve excellence in our service

Primary care
Is the example industry-sponsored in any way?