Improving Bisphosphonate Use and Evaluation in a Rural Family Medicine Practice.

Objective: To evaluate the prevalence of bisphosphonate use without a drug holiday and to assess the success of an interdisciplinary approach to manage and discontinue bisphosphonate therapy.

Setting: The study was completed at one rural family medicine center.

Practice Description: The practice employs two fulltime pharmacists. Clinical pharmacists' responsibilities include chronic care management as well as collaboration with the team during interdisciplinary clinics. Clinical pharmacists frequently collaborate with other professionals on medication evaluations and quality improvement projects.

Practice Innovation: The pharmacy team and medical resident collaborated to determine appropriateness of bisphosphonate use. This was a two-phase evaluation. In the first phase, therapies were evaluated based on duration and consistency with guideline recommendations based on a retrospective chart review. In the second phase, the pharmacy and medicine team determined if therapy warranted further continuation or if a drug holiday was needed. The team reached out to providers proactively and provided patient and provider education on discontinuing therapy.

Main Outcome Measurements: Patient demographics, bisphosphonate regimen and duration of prescription, frequency of drug holidays, and success rate of therapy discontinuation.

Results: Bisphosphonates were prescribed for an average of 4.2 years with 56 patients prescribed therapy for >5 years. Twenty-one of the 56 patients had a history of a drug holiday, and 13 of the 35 remaining patients had therapy discontinued or a drug holiday was initiated based on the team's recommendation. Patients were more likely to be prescribed therapy for >5 years if they were older and had more provider appointments.