Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

Kastner, Monika; Straus, Sharon E.

doi:10.1007/s11606-008-0871-y

Cited by 17 publications

(4 citation statements)

References 61 publications

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“…A systematic review has shown that disease management tools for osteoporosis that targeted both the physician and patient and that were multifaceted (such as having reminders, education and risk assessment tools in either paper or electronic format) improved appropriate use of both bone mineral density testing and treatment. 69 Several Canadian randomized controlled trials have demonstrated the effectiveness and cost-effectiveness of multifaceted approaches in which case managers coordinate care. 70,71 Therefore, we developed a toolkit and a dissemination strategy after widespread national consultation with primary care physicians, patients, allied health professionals, specialists, radiologists and health policy-makers.…”

Section: Knowledge Translationmentioning

confidence: 99%

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

Παπαϊωάννου

Morin²,

Cheung³

et al. 2010

Canadian Medical Association Journal

1,174

958

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Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures.1,2 The focus now is on preventing fragility fractures and their negative consequences, rather than on treating low bone mineral density, which is viewed as only one of several risk factors for fracture. Given that certain clinical factors increase the risk of fracture independent of bone mineral density, it is important to take an integrated approach and to base treatment decisions on the absolute risk of fracture. Current data suggest that many patients with fractures do not undergo appropriate assessment or treatment.3 To address this care gap for high-risk patients, the 2010 guidelines concentrate on the assessment and management of women and men over age 50 who are at high risk of fragility fractures and the integration of new tools for assessing the 10-year risk of fracture into overall management. Burden and care gapsFragility fractures, the consequence of osteoporosis, are responsible for excess mortality, morbidity, chronic pain, admission to institutions and economic costs. [4][5][6] They represent 80% of all fractures in menopausal women over age 50.3 Those with hip or vertebral fractures have substantially increased risk of death after the fracture.5 Postfracture mortality and institutionalization rates are higher for men than for women. 7Despite the high prevalence of fragility fractures in the Canadian population and the knowledge that fractures predict future fractures, 8 fewer than 20% of women 3,9 and 10% of men 10 receive therapies to prevent further fractures. These statistics contrast sharply with the situation for cardiovascular disease, where 75% of patients who have had myocardial infarction receive β-blockers to prevent another event. 11 Scope of the guidelinesThe target population for these guidelines is women and men over age 50, because of the overall burden of illness in that age group. As a consequence, we focused our systematic literature reviews on this population. The application of these guidelines to children and young adults, as well as high-risk groups such as transplant recipients, was considered, but indepth reviews of conditions that increase risk were largely beyond the scope of these guidelines. Development of the guidelinesThe development of these guidelines followed the Appraisal of Guidelines, Research and Evaluation (AGREE) framework. 12 We surveyed primary care physicians, patients, osteoporosis specialists from various disciplines, radiologists, allied health professionals and health policy-makers to identify priorities for these guidelines. We then conducted system-

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Section: Knowledge Translationmentioning

confidence: 99%

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

Παπαϊωάννου

Morin²,

Cheung³

et al. 2010

Canadian Medical Association Journal

1,174

958

View full text Add to dashboard Cite

show abstract

“…Such information systems help identify and screen patients who are due for preventive services, independent of direct doctor contact. A review of randomized controlled trials of the use of computerized prompts for the provider at the point of care found an increased rate of bone mineral density testing [15].…”

Section: Introductionmentioning

confidence: 99%

Use of a clinical decision support system to increase osteoporosis screening

DeJesus

2012

Evaluation Clinical Practice

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Background In 2002, the US Preventive Services Task Force recommended routine osteoporosis screening for women aged 65 years or older. However, studies have indicated that osteoporosis remains underdiagnosed, and various methods such as the use of health information technology have been tried to increase screening rates. We investigated whether we could boost the low rates of bone mineral density testing with implementation of a point-of-care clinical decision support system in our primary care practice. Methods We retrospectively reviewed the medical records of female patients eligible for osteoporosis screening who had no prior bone mineral density test who were seen at our primary care practice sites in 2007 or 2008 (before and after implementation of a pointof-care clinical decision support system). Results Overall, screening rates were 80.1% in 2007 and 84.1% in 2008 (P < 0.001). Of patients who did not have osteoporosis screening before the visit, 5.87% completed the screening after the visit in 2007, compared with 9.79% in 2008 (when the clinical support system was implemented), a 66.7% improvement (P = 0.025). Conclusion Clinical decision support for primary care doctors significantly improved osteoporosis screening rates among eligible women. Carefully designed clinical decision support systems can optimize care delivery, ensuring that important preventive services such as osteoporosis screening for patients at risk for fracture are performed while unnecessary testing is avoided.

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“…Despite this perceived need for pharmacotherapy, there are high rates of treatment non-adherence for osteoporosis, with an estimated 50% of patients not taking medications by 12 months 75 . Educating patients regarding the benefits and rationale for effective pharmacotherapies for osteoporosis, a largely asymptomatic condition in the absence of fracture, may help to improve patient adherence with therapies and health outcomes, particularly a reduction in fracture risk 76,77 . This contrasts with other chronic musculoskeletal conditions such as osteoarthritis, low back pain and inflammatory arthritis, where the perceived need for pharmacotherapy is often driven by a desire for symptom and pain control and maintenance of function and mobility 24,73,[78][79][80] .…”

Section: Discussionmentioning

confidence: 99%

Systematic scoping review of patients’ perceived needs of health services for osteoporosis

et al. 2017

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Health service planners, administrators and providers need to understand the patients' perspective of health services related to osteoporosis to optimise health outcomes. The aims of this study were to systematically identify and review the literature regarding patients' perceived health service needs relating to osteoporosis and osteopenia. A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoporosis health services were categorised. Thirty-three studies (19 quantitative and 14 qualitative) from 1027 were relevant. The following areas of perceived need emerged: (1) patients sought healthcare from doctors to obtain information and initiate management. They were dissatisfied with poor communication, lack of time and poor continuity of care. (2) Patients perceived a role for osteoporosis pharmacotherapy but were concerned about medication administration and adverse effects. (3) Patients believed that exercise and vitamin supplementation were important, but there is a lack of data examining the needs for other non-pharmacological measures such as smoking cessation and alcohol. (4) Patients wanted diagnostic evaluation and ongoing surveillance of their bone health. This review identified patients' needs for better communication with their healthcare providers. It also showed that a number of important cornerstones of therapy for osteoporosis, such as pharmacotherapy and exercise, are identified as important by patients, as well as ongoing surveillance of bone health. Understanding patients' perceived needs and aligning them with responsive and evidence-informed service models are likely to optimise patient outcomes.

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Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

Cited by 17 publications

References 61 publications

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

Use of a clinical decision support system to increase osteoporosis screening

Systematic scoping review of patients’ perceived needs of health services for osteoporosis

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