A Quality Improvement Project to incorporate routine Bone Health assessment into a Parkinson’s Clinic
Abstract
Introduction
People with Parkinson’s (PWP) are twice as likely to fracture and over twice as likely to develop osteoporosis (1. Henderson et al, Parkinsonism & Related Disorders, 2019, Vol.64, pp.181-187). This is associated with significant morbidity (1). Assessment of bone health is often overlooked in clinic (2. UK Parkinson’s Excellence Network, 2019, pp.4-56), deeming it a priority area for improvement. Our project focuses on implementing routine bone health assessment for PWP in clinic, to achieve better standards of care.
Methods
This was a 12-week medical student led project, supported by the specialist multi-disciplinary Parkinson’s team (MDT) in Cardiff and Vale. To establish baseline current practice, a retrospective fracture risk assessment was completed for 141 patients using the Bone-Park algorithm (1). To screen bone health, we developed a bone health proforma, incorporating the FRAX tool. We trialled proforma integration in clinic, by gaining patient feedback and analysing logistics. Administration was done in a patient, healthcare assistant (HCA) and clinician led format.
Results
The retrospective analysis showed that 61.7% (n=87/141) of patients required bone health intervention. Of these patients, 41.4% required vitamin D supplementation. 40.2% required bone density measurement. 18.4% required bone strengthening treatment. This was subsequently initiated. Issues identified with patient-administered forms (n=8/30) were physical difficulty in completing forms and confusion around medical terminologies, which clinician led administration (n=14/30) could support. HCA’s (n= 8/30) required MDT support to complete forms.
Conclusions
As PWP have an increased fracture risk (1), our results provide compelling evidence that routine bone health assessment should be better integrated into Parkinson’s management. Clinician led administration of our proforma was the best model of integration. This was based on patient preference, a reduction in duplication and improved accuracy. Further bone health education is needed within our MDT, which we aim to incorporate through our Parkinson’s web application.
Comments
Really impressive QI project…
Really impressive QI project and the finding that 61.7% of patients required bone health intervention really underscores how overlooked this area has been in routine Parkinson's care. The head-to-head comparison of HCA-led, patient-led, and clinician-led administration adds real practical value.
A couple of questions that came to mind:
- Were any patients excluded from the retrospective cohort, for example those with incomplete records or very recent diagnosis?
- In the clinician-led arm, did you capture roughly how long the proforma added to a consultation? This could be important for wider roll-out across busy MDT clinics.
- The mention of a Parkinson's web application for MDT education is intriguing - is this something you're developing locally, and do you plan to share it more widely?