Integrating Osteoporosis in Primary Care: The Osteoporosis Risk and Management (ORMA) Project

In this stepped wedge design, general practices will be randomly allocated to start the intervention every 4 weeks. Intervention: Use of CAT-Osteoporosis by clinicians. CAT-Osteoporosis is a module, part of CAT (Clinical Audit Tool) software developed by PenCS which uses graphs and reports to identify patients in risk of osteoporosis (Primary prevention) or to identify patients who require an improved disease management (Secondary prevention) by general practitioners. Graphs and reports contain variables such as date of birth, sex, life style factors, androgen deficiency, menopause status, osteoporosis diagnosis, minimal trauma fracture, date of last fracture and recurring fracture which help the general practitioner to visually determine the health status of the participant. Once general practices are randomized to start the intervention, they will have continuous access to the hotline, website and printer materials and it could be used as their discretion. The study is implemented as follow: -Recruitment: This phase involves the initial contact with the general practices. The Study team will work with the local Primary Health Network (PHN) whenever possible to engage with general practices. A total of 16 general practices will be invited to participate in the study. -Phase I Pre-implementation: Involves the installation/integration of the CAT-Osteoporosis tool in the general practice PenCS software (previous consent from GPs). During this phase, GPs will not be able to determine whether the CAT-Osteoporosis tool has been installed in their computers, they will not receive any additional information on the module and will not be allowed to generate any reports. This phase will have a duration of 4 weeks and it will involve the export of baseline data from the PenCS system and the collection of practice-based characteristics (overall number of patients registered, number of GPs employed, combined EFT of GP employed, gender distribution of doctors, additional services offered at the clinic) -Phase II Implementation: This phase involves the progressive (stepped wedge) implementation of CAT-Osteoporosis into 2 general practices every 4 weeks. GPs will receive a Quick Reference Guide (supplied by PenCS) in using the CAT and will be provided with teaching materials on osteoporosis detection and treatment (provided by Osteoporosis Australia), along with copy of the current RACGP osteoporosis guidelines. In addition, GPs will have access to a hotline (run by the Clinical Research Coordinator and Clinical Research Fellow (CI Zanker)) which will provide them with guidance on using the system and on decision-making processes. -Phase III Post Implementation: During this phase data will be collected from general practices using CAT-Osteoporosis. This phase will involve monthly data extracts and will have a duration of 4 months. Once the last data extract has been collected, general practitioners involved in the study will proceed to fill up the post-implementation survey. As this study is considered a Quality Improvement activities. General practices involved will meet the requirements for the Quality Improvement Incentive (QI) part of the Practice Incentive Program (PIP).