Aims: Osteoporosis is highly prevalent in older adults, and is often treated with denosumab, a six-monthly injection. Until recently at Western Health, a tertiary hospital in metropolitan Melbourne, the default prescribing frequency on Electronic Medical Records (EMR) was “once only”. We aimed to determine whether changing the prescribing default frequency for denosumab from “once only” to “6 monthly” on EMR led to increased post-discharge adherence.
Methods: A retrospective pre- and post-implementation study was conducted at Western Health, including inpatients aged 65 years and older with osteoporosis newly initiated on denosumab between July 2022–November 2023, and with available My Health Record data. The default prescription frequency on EMR changed in March 2023. Between-group differences in denosumab adherence within an eight-month window were assessed using dispensing data on My Health Record.
Results: We included 230 patients in the study: 87 pre-intervention, and 143 post-intervention groups. Following the EMR intervention, six-monthly prescriptions for denosumab increased from 23.0% to 95.8%. Prescriptions on discharge improved from 80.5% to 93.0% and adherence at eight months improved from 48.3% to 63.6%. The odds of adherence was 1.88 times greater after the intervention compared to the prior (95% CI: 1.09-3.22, p=0.02), with the effect of the intervention most pronounced in patients discharged to a private residence (OR=3.30, 95% CI: 1.61-6.74, p<0.01).
Conclusions: Changing the default prescribing frequency of denosumab on EMR improved early adherence after discharge from the hospital. Further strategies are required to address residual gaps in long-term adherence.