Adherence with osteoporosis practice guidelines: A multilevel analysis of patient, physician, and practice setting characteristics

Solomon, Daniel H.; Brookhart, M. Alan; Gandhi, Tejal K.; Karson, Andrew S.; Gharib, Soheyla D.; Orav, E. John; Shaykevich, Shimon; Licari, Andrea; Cabral, Danielle; Bates, David W.

doi:10.1016/j.amjmed.2004.06.040

Cited by 93 publications

(79 citation statements)

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“…(70)(71)(72) However, many patient and provider factors lead to noncompliance. (73) In a survey of older adults, increased weight was associated with both level of belief in susceptibility to osteoporosis and efficacy of screening. (74) Although screening acceptance for osteoporosis has not been as well-studied as for cancer screening, for instance, it is likely that weight presents a similar patient barrier for DXA screening as for mammography.…”

Section: Bone Density Testing In Overweight and Obese Individualsmentioning

confidence: 99%

“…(75) Comorbidities that are more frequent in obese people may also play a role in a lower frequency of screening. (69,73) While DXA screening is one area of focus, screening among overweight and obese populations for low and declining physical function, fall risk, and insufficiency of vitamin D and other nutrients may have even greater returns in improving not just bone health but also mobility and quality of life.…”

Section: Bone Density Testing In Overweight and Obese Individualsmentioning

confidence: 99%

See 1 more Smart Citation

Obesity and fracture in men and women: An epidemiologic perspective

Nielson

Srikanth

Orwoll

2011

Journal of Bone and Mineral Research

214

137

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In Western societies, mean body weight has increased dramatically in older people, and a similar trend exists in Asia. Yet insufficient attention has been directed to the problem of osteoporotic fractures in the overweight and obese. Many, if not most, osteoporotic fractures occur in overweight or obese people, and obese men may be particularly susceptible. We discuss the potential implications of these findings, including the challenge of identifying individuals at highest risk, screening and treatment strategies, and future research directions. ß

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Section: Bone Density Testing In Overweight and Obese Individualsmentioning

confidence: 99%

Section: Bone Density Testing In Overweight and Obese Individualsmentioning

confidence: 99%

Obesity and fracture in men and women: An epidemiologic perspective

Nielson

Srikanth

Orwoll

2011

Journal of Bone and Mineral Research

214

137

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“…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.…”

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confidence: 99%

Interventions to Improving Osteoporosis Screening: An Iowa Research Network (IRENE) Study

Levy¹,

Hartz²,

Woodworth³

et al. 2009

The Journal of the American Board of Family Medicine

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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.

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“…There are many hurdles to overcome in optimising the use of guidance, ranging from awareness of its existence to implementation and impact on individual care. Low awareness will always result in low adherence but, even with detailed plans and processes for implementation, clinician knowledge of such guidelines is relatively low world-wide for osteoporosis [18][19][20][21] and other chronic diseases. Education is obviously important but its effectiveness can be disappointing; for example, a Cochrane review reported that continuing medical development meetings led to only relatively small improvements in practice and patient outcomes [22].…”

Section: Discussionmentioning

confidence: 99%