Specialist bone and mineral rapid access clinics provide timely osteoporosis assessment. Assessing specialist bone clinic utilisation and discharge pathways may assist in optimising service delivery. We aimed to compare patient characteristics, clinical encounter frequency and discharge destinations in patients managed in a hospital-based specialist bone and mineral telehealth rapid access clinic service (Bone-TRACS), which aimed to deliver a maximum of three clinical encounters.
We performed a retrospective audit of 426 patients with osteoporosis, with or without prior fracture, receiving the Bone-TRACS model-of-care over a two-year period. Patients were categorised according to whether they underwent a specialist-directed osteoporosis pharmacotherapy change (defined as initiation of bisphosphonate, denosumab or anabolic therapy) in relation to referral source, clinical characteristics (including fracture history and osteoporosis therapy), bone mineral density (BMD), clinical encounter frequency and discharge destination.
Of 426 patients, 210 (49%) had an osteoporosis pharmacotherapy change and 216 (51%) did not. Compared with patients without treatment change, treatment-change patients were older (65 vs 60 years), more commonly women (81% vs 76%), had similar overall internal referral proportions (66% vs 68%) but more internal referrals for fracture (35% vs 30%) and lower baseline lumbar spine, total hip and femoral neck BMD. Treatment change was associated with more clinical encounters (75% vs 40% received three encounters, p<0.001), more subsequent specialist bone and mineral mainstream clinic follow-up (63% vs 48%, p=0.002) and fewer discharges to primary care (26% vs 43%, p<0.001).
Approximately half of Bone-TRACS patients received an osteoporosis medication change, and this group had lower BMD, more fractures and more specialist follow-up. While patients not receiving medication changes had relatively higher discharge rates to primary care, most were still designated for long-term specialist follow-up. These observations may inform future specialist osteoporosis clinic models-of-care to facilitate continuation of primary care.