Acceptability and Feasibility of an Evidence-Based Requisition for Bone Mineral Density Testing in Clinical Practice (original) (raw)
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Journal of Osteoporosis, 2016
Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontario’s family physicians (FPs).Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing.Results. We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described.Conclusions. These findings lend support to what has been documented a...
Developing a bone mineral density test result letter to send to patients: a mixed-methods study
Patient Preference and Adherence, 2014
Abstract PURPOSE: To use a mixed-methods approach to develop a letter that can be used to notify patients of their bone mineral density (BMD) results by mail that may activate patients in their bone-related health care. PATIENTS AND METHODS: A multidisciplinary team developed three versions of a letter for reporting BMD results to patients. Trained interviewers presented these letters in a random order to a convenience sample of adults, aged 50 years and older, at two different health care systems. We conducted structured interviews to examine the respondents' preferences and comprehension among the various letters. RESULTS: A total of 142 participants completed the interview. A majority of the participants were female (64.1%) and white (76.1%). A plurality of the participants identified a specific version of the three letters as both their preferred version (45.2%; P<0.001) and as the easiest to understand (44.6%; P<0.01). A majority of participants preferred that the letters include specific next steps for improving their bone health. CONCLUSION: Using a mixed-methods approach, we were able to develop and optimize a printed letter for communicating a complex test result (BMD) to patients. Our results may offer guidance to clinicians, administrators, and researchers who are looking for guidance on how to communicate complex health information to patients in writing.
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...
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2003
Large population-based surveys have shown that approximately 30% of people over age 65 years have osteoporosis and that 17% of the population over 65 years will sustain a fracture during their lifetime. Many people with osteoporosis are never being evaluated even though effective treatments are available. We examined why primary care physicians order few bone mineral density scans. We conducted a cross-sectional survey of primary care physicians practicing in any of the six New England states. Target physician specialties included internal medicine, general practitioners/family physicians, and obstetrician-gynecologists who had a facsimile number listed with the American Medical Association. Demographics, practice characteristics, use of bone densitometry, and attitudes regarding osteoporosis, bone densitometry and health maintenance were assessed by questionnaire. Twelve percent (n=494) of the physicians responded to the questionnaire. Respondents were similar to non-respondents wi...
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.
Bone mineral density measurements: are they worth while?
Journal of the Royal Society of Medicine, 1996
Bone mineral density measurements have been criticized on the grounds that they are not a worth-while screening tool. In this paper we argue that bone mineral measurements can be an efficient diagnostic tool even if they are not of proven value for screening. There is complex relationship between the costs of a measurement, the intervention and the predictive value of the test all of which must be accounted for when assessing the value of a bone density measurement. For bone density measurements to be used for screening, a wider evaluation needs to be undertaken compared with that for their use as a diagnostic tool. We address some common objections, for example, that low compliance with screening would undermine efficiency, and show that these are not relevant. Evaluations of screening need to address issues that are likely to affect efficiency.
Recommendations for bone mineral density reporting in Canada
PubMed, 2005
Objective: To propose a set of recommendations for optimal bone mineral density (BMD) reporting in postmenopausal women and older men and to provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture. Options: The current methods of BMD reporting were reviewed. In this document, we propose that an individual's 10-year absolute fracture risk, rather than BMD alone, be used for fracture risk categorization. Consequently, age, sex, BMD, fragility fracture history, and glucocorticoid use are the basis for the approach outlined in this document. Outcomes: An optimal BMD report as proposed in this document will provide clinicians with both a BMD diagnostic category and a useful tool to assess an individual's risk of osteoporotic fracture. A BMD report format, a checklist, and a patient questionnaire are meant to further encourage its use. Evidence: All recommendations were developed using a consensus from clinicians and experts in the field of BMD testing and a standard method for the evaluation and citation of the supporting evidence. Values: These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of the Osteoporosis Society of Canada and the Canadian Association of Radiologists. BENEFITS, HARM, AND COSTS: Optimal BMD reports help the practitioner to assess an individual's risk for osteoporotic fracture and to decide whether medical therapy is warranted. Recommendations: The BMD report should include: patient identifiers. Dual-energy X-ray absorptiometry (DXA) scanner identifier. BMD results expressed in absolute values (g/cm2; 3 decimal places) and T-score (1 decimal place) for lumbar spine; proximal femur (total hip, femoral neck, and trochanter); and an alternate site (forearm BMD preferred: 1/3 radius, 33% radius or proximal radius) if either hip or spine is not valid. A statement about any limitations due to artifacts, if present. The fracture risk category (low, moderate, or high) as determined by using Tables 3 and 4 and by including major clinical factors that modify absolute fracture risk probability (with an indication of the corresponding absolute 10-year fracture risk of <10%, 10-20%, or >20%). A statement as to whether the change is statistically significant or not for serial measurements. The BMD centre's least significant change for each skeletal site (in g/cm2) should be included. Validation: Recommendations were based on consensus opinion. Since these are the first Canadian recommendations integrating clinical risk factors in a quantitative fracture risk assessment, it is anticipated that these "Recommendations for BMD Reporting in Canada" will be a work in progress and will be updated periodically to accommodate advances in this field.
Osteoporosis International, 2005
Bone density measurement plays a key role in the initial diagnostic assessment of osteoporosis and in targeting pharmacologic therapies. The impact of access to dual-energy X-ray absorptiometry (DXA) on physician prescribing habits is unclear, however. We were able to directly evaluate the change in physician osteoporosis testing and prescribing following introduction of a DXA testing service in a geographic region that had previously had very limited access. This evaluation was conducted in the province of Manitoba, Canada, which has a provincially based bone density testing program and maintains a population-based bone density database that can be linked with administrative health data sources including drug prescriptions. The province of Manitoba was geographically partitioned into the urban and rural health regions serviced by the new program (urban new and rural new ) and the remaining urban and rural health regions which had relatively unchanged DXA access during this period (urban control and rural control ). Regression models of DXA testing rates and osteoporosis prescription rates were created for all older women in these regions. There was a statistically significant increase in bone density testing and BMDguided osteoporosis treatment in the urban new and rural new regions following introduction of the DXA testing service, relative to the control regions. Although the overall rate of empiric postfracture and preventive osteoporosis treatment did not show a specific region effect, when analysis was limited to nonhormonal agents there was a significant reduction in preventive and empiric postfracture treatment in some subgroups of women. These results suggest that the local availability of the bone density testing service led to an increase in objective test-guided therapy with some reduction in the use of empiric and preventive strategies and had a neutral effect on overall use of these agents.