AB0990 Three years improvement in osteoporosis treatment adherence following a therapeutic patient education (TPE) program
Authors: D. Poivret, V. Noirez, C. Goetz, C. Wilcke
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The management of osteoporosis requires a restrictive drug treatment over several years and lifestyle changes: maintaining a suitable physical activity, a sufficient calcium intake and maintenance of ground balance. Unfortunately, treatment adherence at one year doesn't exceed 50%. The education of the patient allows to take care of himself in his therapeutic approach but requires a relay to continue the follow-up over several years. <h3>Objectives</h3> To improve the follow-up of the patient, we created a cooperation between the doctor and the pharmacist. <h3>Methods</h3> We suggested to patients treated for osteoporosis by diphosphonate, denosumab or teriparatide to participate at two half-day TPE sessions, one year apart. It's taught that osteoporosis requires at least 5 years of treatment, and must be associated with the absorption of three daily dairy products, maintaining physical activity and preventing falls. A follow-up notebook that contains 6 doctor and 6 pharmacist questionnaires is given to each patient participating in a TPE session. The patient sends his book to the doctor, and then to the pharmacist twice a year for three years. The pharmacist questionnaire explains the drug intake. The doctor questionnaire evokes lifestyle changes. This one is completed by the patient in the waiting room and is discussed with the doctor during the consultation. Each completed questionnaire provides a financial compensation to the health professional. The program is funded by the Regional Health Agence of Lorraine and by the Regional Union of Health Professionals (doctors and pharmacists). Inclusions started in January 2013. We studied the results of the 3 year questionnaires for 94 patients included in 2013 and 2014. <h3>Results</h3> Among the 94 patients, only 49 continue their treatment at 3 years. Patients who stopped treatment, 4 died, 1 presented an atypical fracture of the femoral shaft, 6 stopped due to dental treatment, 4 had a contraindication to any anti-osteoporosis treatment, 1stopped treatment due to multiple sclerosis 11 left the program, 2 had poorly tolerated the infusion and 1 discontinued treatment because of improved bone mineral density (BMD). Among the 49 patients who continue their treatment, 13 returned a doctor and pharmacist questionnaire at 3 years. There are 4 doctors and 2 pharmacists who refused to fill out the questionnaire, 20 patients didn't agree to respond to our request for news about their health condition and 4 patients lost to follow-up. The study of 13 questionnaires received shows that at 3 years, 38% of patients continue to consume 3 daily dairy products against 56% at 6 months. Nearly 70% of patients maintained their physical activity, 8% improved and 8% decreased it. It also shows that 46% of patients walk more than 30 min per day. The ground balance is satisfactory for 62% of patients compared to 71% at 6 months. Regarding compliance, at 6 months and 3 years, only 69% of patients never forget their treatment and 15% wanted to stop it. During the 3 years of follow-up, all patients were re-contacted at least once. <h3>Conclusions</h3> 52% of patients included continue the treatment at 3 years. 21% refuse to participate in the program. The doctor/pharmacist collaboration around the patient requires time and understanding. Patients recall and their participation in a research program improves their adherence to treatment and lifestyle changes. <h3>Disclosure of Interest</h3> None declared