Metasynthesis of Patient Attitudes Toward Bone Densitometry

Seaman, Aaron; Steffen, Melissa; Doo, Taisha; Healy, Heather; Solimeo, Samantha L.

doi:10.1007/s11606-018-4587-3

Cited by 8 publications

(7 citation statements)

References 52 publications

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“…Screening, risk assessment tools and collection of good data are all meaningless if physicians are not able to include bone health assessments in routine patient care. Primary care providers can strongly influence their patients' behaviour by providing information that can impact decision-making [32]. When providers fail to discuss bone health with their patients, the patients may not realise that they should be thinking about their skeletal wellbeing or understand the importance of obtaining screening or pursuing other risk assessments [32].…”

Section: Role Of Integrated Care Pathwaysmentioning

confidence: 99%

Improving bone health: addressing the burden through an integrated approach

Bussell

2021

Aging Clin Exp Res

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As people age, maintaining mobility becomes increasingly imperative, therefore addressing bone health is the most important way to preserve mobility. Poor bone health encompasses a broad spectrum of diseases, but it is most often quantified as the cumulative burden of osteoporosis and osteoporotic fractures. Rates of these fractures have been increasing and are expected to continue rising globally, attributed to increasing life expectancy worldwide. No single strategy will be sufficient to address this global public health issue. Co-ordination across a wide array of stakeholders is vital to decrease the health and socioeconomic burden of poor bone health. Stakeholders include an assortment of specialists ranging from health professionals (primary and secondary care clinicians, nurses, physical therapists, and social care workers), policy-makers, government bodies (including departments of health and social services), employers, civil society, as well as patients and their caregivers. We need to ensure that there is a better understanding of the socioeconomic and health consequences of poor bone health to promote better policies to address needs. Building a more resilient health system approach to bone health based on the evidence and sound decision-making will not only improve population health, but will provide cost savings to health systems by preventing poor bone health in the first place. Health systems around the world must prioritise bone health to preserve mobility and wellbeing in advance of the impending surge in demand from ageing populations. Poor bone health is not an inevitable part of ageing. Working across the lifespan, we can all benefit from improved bone health throughout our lives.

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Section: Role Of Integrated Care Pathwaysmentioning

confidence: 99%

Improving bone health: addressing the burden through an integrated approach

Bussell

2021

Aging Clin Exp Res

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“…A recent qualitative metasynthesis (13) identified 10 studies examining patient barriers to DXA. Although most subjects were White women and thus not necessarily representative of older Veterans, the findings there suggest that patient engagement with osteoporosis care is affected by: osteoporosis's asymptomatic nature; perceived age and gender stigma associated with an osteoporosis diagnosis (17)(18)(19)(20)(21)(22) ; confusion about the DXA's purpose; the belief that osteoporosis is not a serious health concern; the relatively lower ranking of osteoporosis in relation to other health conditions; and the belief that osteoporosis fractures are not indicative of disease but arise from poor luck.…”

Section: Discussionmentioning

confidence: 99%

“…Although most subjects were White women and thus not necessarily representative of older Veterans, the findings there suggest that patient engagement with osteoporosis care is affected by: osteoporosis's asymptomatic nature; perceived age and gender stigma associated with an osteoporosis diagnosis (17)(18)(19)(20)(21)(22) ; confusion about the DXA's purpose; the belief that osteoporosis is not a serious health concern; the relatively lower ranking of osteoporosis in relation to other health conditions; and the belief that osteoporosis fractures are not indicative of disease but arise from poor luck. (13,23) Low rates of osteoporosis medication initiation, adherence, and persistence are well documented, but there has been comparatively little attention paid to patient rationale underlying these patterns, particularly in the context of primary prevention approaches. (24) Recent pharmacological research suggests that fear of rare side effects (i.e., atypical fracture or osteonecrosis of the jaw) is driving low initiation rates.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are studies examining knowledge and other factors in the context of secondary prevention models, (11) to our knowledge there are little to no data examining the patient experience in the context of a primary prevention model such as the RBHT. Thus, we used an "exploratory descriptive design," (12) including conducting a literature review, (13) purposive sampling, (14) semistructured interviewing, and thematic analysis. (15) Interview questions focused on the patient's experience of care or their decision to not accept care from the RBHT as well as their knowledge of osteoporosis and the impact it may have had on their lives.…”

Section: Methodsmentioning

confidence: 99%

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Attitudes toward bone health among rural‐dwelling veterans identified as at risk of fracture: a qualitative analysis

et al. 2021

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Although much is known about system-level barriers to prevention and treatment of bone health problems, little is known about patient-level barriers. The objective of this study was to identify factors limiting engagement in bone health care from the perspective of rural-dwelling patients with known untreated risk. Over 6 months, 39 patients completed a qualitative interview. Interview questions focused on the patient's experience of care, their decision to not accept care, as well as their knowledge of osteoporosis and the impact it has had on their lives. Participants were well-informed and could adequately describe osteoporosis and its deleterious effects, and their decision making around accepting or declining a dual-energy x-ray absorptiometry (DXA) scan and treatment was both cautious and intentional. Decisions about how to engage in treatment were tempered by expectations for quality of life. Our findings suggest that people hold beliefs about bone health treatment that we can build on. Work to improve care of this population needs to recognize that bone health providers are not adding a behavior of medication taking to patients, they are changing a behavior or belief.

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“…Such initiatives have been shown to be cost‐effective mechanisms for facilitating DXA and medication initiation, but implementation requires significant organizational commitment and coordination across laboratory, imaging, primary care, nursing, and pharmacy services . Similarly, adoption of primary care‐based management of osteoporosis, though patient‐centered, faces considerable and time‐consuming care coordination to monitor patients across inpatient, short‐term rehabilitation, pharmacy, and outpatient settings …”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study

et al. 2019

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Rates of postfracture DXA and pharmacotherapy appear to be declining despite their known benefits in fracture reduction. We sought to identify factors associated with osteoporosis care among male veterans aged 50 years and older after hip fracture and to evaluate trends in rates of care with an observational cohort design using US Department of Veterans Affairs’ (VA) inpatient, pharmacy, and outpatient encounters and Centers for Medicare and Medicaid Services outpatient pharmacy claims (2007 to 2014) from men aged 50 years and older treated for hip fracture (N = 7317). We used the Cox proportional hazards model with random effects for the admitting facility. A sensitivity analysis was performed for a subset of patients aged 65 to 99 dually enrolled in Medicare ( N = 5821). Overall, approximately 13% of patients had evidence of osteoporosis care within one year of fracture. In the adjusted model, rural residence was associated with lower likelihood of care, and several comorbidities were associated with higher likelihood of receiving care. In sensitivity analyses of patients dually enrolled in Medicare, rural residence remained associated with lower likelihood of osteoporosis care. Overall rates of care decreased over time, but rates of DXA in the VA remained stable. These findings highlight the ongoing problem of low rates of postfracture care among a population with the highest risk of future fracture and its associated morbidity and mortality. The rural disparity in care and differences in rates of care across healthcare delivery systems illustrates the importance of healthcare delivery systems in promoting pharmacotherapy and DXA after sentinel events. Because the VA removes a majority of cost barriers to care, this integrated healthcare system may outperform the private sector in access to care. However, declining rates of pharmacotherapy imply knowledge gaps that undermine quality care. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Metasynthesis of Patient Attitudes Toward Bone Densitometry

Cited by 8 publications

References 52 publications

Improving bone health: addressing the burden through an integrated approach

Improving bone health: addressing the burden through an integrated approach

Attitudes toward bone health among rural‐dwelling veterans identified as at risk of fracture: a qualitative analysis

Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study

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