Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study (original) (raw)
Related papers
Population Health Management, 2009
Family physicians' personal and practice characteristics may influence how osteoporosis is managed. Thus, we evaluated the impact of family physicians' personal and practice characteristics on the appropriate use of bone mineral density testing and osteoporosis therapy. The physician questionnaire assessed 13 personal and practice characteristics of the physicians. The patient questionnaire was used to collect data to ascertain how family physicians managed osteoporosis. A total of 225 family physicians from 7 provinces across Canada completed both the physician and patient questionnaires. The family physicians evaluated a total of 5601 patients. The generalized estimating equations technique was utilized to model the associations between family physicians' personal and practice characteristics and appropriate use of bone mineral density testing and osteoporosis therapy. Odds ratios (OR) and corresponding 95% confidence intervals (CI) are reported. Findings indicated that female family physicians have higher odds of administering appropriate bone density testing compared to male family physicians (OR: 1.28; 95% CI: 1.05, 1.55), and that physicians who have hospital privileges (OR: 0.77; 95% CI: 0.62, 0.97) and who graduated more recently from medical school (OR: 0.87; 95% CI: 0.77, 0.99) have lower odds of administering appropriate bone mineral density tests. Physicians who use electronic health records have higher odds of administering appropriate therapy (OR: 1.30; 95% CI: 1.06, 1.59) as compared to physicians who do not use them. Several family physicians' personal and practice characteristics are associated with appropriate utilization of bone mineral density testing and therapy. The education of both clinicians and policy makers regarding these new insights may translate to enhanced individual practices and an improved overall health care system to optimize the environment for managing osteoporosis.
Patterns of use of the bone mineral density test in Ontario, 1992-1998
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2000
There is ongoing controversy about who should be referred for bone mineral density (BMD) testing to estimate fracture risk and diagnose osteoporosis. The purpose of this study was to examine patterns of use of BMD testing in Ontario between 1992 and 1998. All physician claims from the Ontario Health Insurance Plan (OHIP) claims database for BMD testing between Jan. 1, 1992, and Dec. 31, 1998, were categorized by age and sex of the patient and the specialty of the physician who ordered the test. Time trends and regional rate variation analyses were also performed. To examine the prevalence of repeat testing, an inception cohort of women who had a BMD test in 1996 was followed for 2 years from the date of first test. From 1992 to 1998 the number of BMD tests performed per year in women increased from 34,402 to 230,936 and in men from 2,162 to 13,579. In 1998 most tests were being ordered by family physicians (80.2% in 1998 v. 52.1% in 1992). Approximately 1 in 7 women aged 55-69 years...
Journal of osteoporosis, 2016
Introduction. The purpose of this study is to understand the experience of primary care providers (PCPs) using an evidence-based requisition for bone mineral density (BMD) testing. Methods. A qualitative descriptive approach was adopted. Participants were given 3 BMD Recommended Use Requisitions (RUR) to use over a 2-month period. Twenty-six PCPs were interviewed before using the RUR. Those who had received at least one BMD report resulting from RUR use were then interviewed again. An inductive thematic analysis was performed. Results. We identified four themes in interview data: (1) positive and negative characteristics of the RUR, (2) facilitators and barriers for implementation, (3) impact of the RUR, and (4) requisition preference. Positive characteristics of the RUR related to both its content and format. Negative characteristics related to the increased amount of time needed to complete the form. Facilitators to implementation included electronic availability and organizationa...
Canadian family physician Médecin de famille canadien
To explore family physicians' experiences and perceptions of osteoporosis and to identify their educational needs in this area. Qualitative study using focus groups. Four Ontario sites: one each in Thunder Bay and Timmins, and two in Toronto, chosen to represent a range of practice sizes, populations, locations, and use of bone densitometry. Thirty-two FPs participated in four focus groups. Physicians were identified by investigators or local contacts to provide maximum variation sampling. Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used to identify key words and concepts until saturation of themes was reached. Family physicians order bone densitometry and try to manage osteoporosis appropriately, but lack a rationale for testing and are confused about management. Participants' main concern was clinical management, followed by disease prevention and their educational needs. Family p...
CMAJ open, 2014
On Apr. 1, 2008, a revision was made to the fee schedule for bone mineral density testing with dual-energy x-ray absorptiometry (DXA) in the province of Ontario, Canada, reducing the frequency of repeat screening in individuals at low risk of osteoporosis. We evaluated whether the change in physician reimbursement successfully promoted appropriate bone mineral density testing, with reduced use among women at low risk and increased use among women and men at higher risk of osteoporosis-related fracture. We analyzed data from administrative databases on physician billings, hospital discharges and emergency department visits. We included all physician claims for DXA in the province to assess patterns in bone mineral density testing from Apr. 1, 2002, to Mar. 31, 2011. People at risk of an osteoporosis-related fracture were defined as women and men aged 65 years or more and those who had a recent (< 6 mo) fracture after age 40 years. Joinpoint regression analysis was used to examine ...
Effect of Self-referral on Bone Mineral Density Testing and Osteoporosis Treatment
Medical Care, 2014
Background-Despite national guidelines recommending bone mineral density screening with dual-energy xray absorptiometry (DXA) in women ≥65 years old, many women do not receive initial screening. Objective-To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral), (2) self-referral plus patient educational materials, and (3) usual care (UC, physician referral). Research Design-Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG). Subjects-Women ≥ 65 years old without a DXA in past 5 years. Measures-DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing. Results-From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0-24.1% self-referral vs. 4.9-5.9% UC, p < 0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared to UC (p < 0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8-3.4%) but significantly greater among self-referral versus UC in KPNW. Conclusions-DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.
Interventions to Improving Osteoporosis Screening: An Iowa Research Network (IRENE) Study
Journal of the American Board of Family Medicine, 2009
Background: Primary care physicians often fail to diagnose low bone density. This pilot study assessed 2 interventions for their effect on bone mineral density testing. Methods: Five practices in the Iowa Research Network were randomized: 2 to chart reminder alone (CR), 2 to chart reminder plus mailed patient education (CR؉PtEd), and one to usual care. A total of 204 women aged 65 years or older were recruited from within these practices. Bayesian hierarchical analyses were used instead of traditional statistical methods to take advantage of collateral data and to adjust for differences between clinics at baseline. Results: After the intervention, the rates of completed bone mineral density testing were 45.2% in the CR؉PtEd group, 31.4% in the chart remainder only group, and 9.7% in the usual care practice. Bayesian analysis adjusted for patient and clinic characteristics, which made use of collateral data, gave an odds ratio of 5.47 for the effect of CR؉PtEd group. The Bayesian P was .029 and the one-sided 95% credible interval for the odds ratio was greater than 1.2. The effect of CR؉PtEd was confirmed by sensitivity analyses. Traditional hierarchical analysis adjusted for practice characteristics could not be used to estimate statistical significance because there were not enough clinics to accommodate a model that included all the important covariables. Conclusions: Specific chart reminders to physicians combined with mailed patient education substantially increased the levels of bone density testing and could potentially be used to improve osteoporosis screening in primary care. Bayesian hierarchical analysis makes it possible to assess practice-level interventions when few practices are randomized. (J Am Board Fam Med 2009;22:360-7.) Low bone density or osteoporosis is common and affects nearly half of postmenopausal women attending primary care practices who have had no previous diagnosis of osteoporosis. 1 These conditions lead to substantial morbidity and mortality, including fractures, disability, and death. 2 Bone mineral density (BMD) screening is the only way to reliably assesses low bone density. 3-5 The National Osteoporosis Foundation guidelines, 6 which are endorsed by 9 specialty societies and the US Preventive Services Task Force, recommend BMD testing for all women aged 65 and older. However, nearly one-half to two-thirds of women attending primary care practices have not received BMD testing, 1,7,8 although rates are improving. 9 It is estimated that Medicare could save millions of dollars with increased BMD testing. 10 This article was externally peer reviewed.
Journal of Clinical Densitometry, 2006
Routine bone mineral densitometry (BMD) screening has been recommended for women aged 65 yr (Osteoporosis Canada [OC], International Society for Clinical Densitometry [ISCD], Canadian and United States Task Forces on Preventative Healthcare, and National Osteoporosis Foundation) and for men 65 yr (OC) or 70 yr (ISCD). We estimated the number of older Canadians needed to screen (NNS) by BMD to detect an undiagnosed case of osteoporosis, using prospective, multicenter, population-based data from the Canadian Multicentre Osteoporosis Study (CaMos). We included participants aged 65 yr with baseline dual-energy X-ray absorptiometry (DXA) BMDs at the femoral neck and lumbar spine (L1eL4). Osteoporosis was defined by a T-score 2.5 at either site. Patients were questioned about a prior diagnosis of osteoporosis. We studied 2699 women and 1032 men aged 65 yr. The percentage prevalence and 95% confidence intervals were determined. In individuals aged 65 yr, the prevalence of osteoporosis was 25.6% in women (95% confidence interval, 24.0%, 27.3%) and 8.9% in men (7.3%, 10.8%). In 652 men aged 70 yr, the prevalence of osteoporosis was 11.3% (9.1%, 14.0%). Of the participants with BMD-defined osteoporosis, 76.6% of woman aged 65 yr (73.2%, 79.6%; 516 of 674 women), 93.4% of men aged 65 yr (86.4%, 96.9%; 85 of 91), and 93.2% of men 70 yr (84.9%, 97.0%; 68 of 73) were not aware of it. Thus, the minimum NNS by BMD testing to detect one previously undiagnosed case of osteoporosis in Canada is: 6 women aged 65 yr, 13 men aged 65 yr, and 10 men aged 70 yr.