Adherence to the U.S. Preventive Services Task Force 2002 Osteoporosis Screening Guidelines in Academic Primary Care Settings

Abstract

We found good adherence to the USPSTF 2002 guidelines for osteoporosis screening in women aged ≥65 years by primary care physicians in a large urban academic medical center. The practice site and not gender of the provider resulted in significantly different screening rates.

Effect of Reimbursement Reductions on Bone Mineral Density Testing for Female Medicare Beneficiaries

“…For example, although performed at academic health centers similar to those in the present study, BMD testing rates performed at facilities with predominantly white population are substantially higher (64%-70% in the past 3 years) than those in the present study. 19,21 Consistent with prior investigations of sites that perform DXA tests, the shift in BMD testing from nonhospital settings (e.g., physicians' offices and independent diagnostic facilities) to hospital settings was observed in the present study. 8,10 Several lines of evidence reflecting physicians' attitudes toward the reimbursement cuts in DXA testing have shown that more than a third of physicians reduced the number of DXA tests and opted to stop investing in DXA machines for their offices.…”

“…We found a significant association between reimbursement reductions and decrease in BMD testing in female Medicare beneficiaries without supplemental private health insurance. (16)(17)(18)(19)(20)(21)(22) 0.67 (0.34-0.98) 0.03 (n = 421) n = 213 n = 208 a Hazard ratios were derived from Cox proportional hazard regressions after adjusting for participant characteristics (age, ethnicity, education, marital status, hazardous lifestyle, health insurance, comorbidities related to bone health, cognitive impairment, and home health or day care services). Hazard ratio > 1 indicates the predicted probability that the BMD test in phase 2 was higher than that in phase 1.…”

External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study

“…5 6 Routine scanning of bone mineral density is recommended in all women and in some guidelines also for men, but despite these recommendations, rates of screening remain low, leaving osteoporosis undiagnosed in many patients. [7][8][9][10] Furthermore, the criteria used for bone mineral density to identify those at high risk for osteoporotic fractures are not highly sensitive, as more than half of older women with osteoporotic fractures do not meet the bone mineral density criteria for osteoporosis (T score lower than −2.5). 11 For these reasons, multiple risk assessment tools based on clinical and personal characteristics have been developed in recent years to identify those at high risk for osteoporotic fractures.…”

Primary care physicians practicing preventive medicine in the outpatient setting

“…Numerous studies to date have examined why guidelines are not being practiced. [ 5 6 7 8 9 10 11 12 13 ] Over 290 barriers to preventive medicine discussions with patients have been explored, including lack of time, patient refusal or hesitance, inadequate insurance reimbursement, and lack of physician knowledge. [ 5 6 ] A study assessing the average amount of time needed daily to discuss all preventive medicine topics per USPSTF recommendations found that 7.4 h per working day would be required.…”