A randomized controlled trial of mailed osteoporosis education to older adults

Solomon, Daniel H.; Finkelstein, Joel S.; Arnold, Marilyn; Licari, Andrea; Cabral, Danielle; Canning, Claire; Avorn, Jerry; Katz, Jeffrey N.

doi:10.1007/s00198-005-0049-y

Cited by 64 publications

(63 citation statements)

References 14 publications

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“…Whether these interventions affect patient outcomes and future fracture incidence has not been well studied. In addition, even if osteoporosis educational materials are provided to patients at risk for osteoporosis, this is often not enough to change knowledge, attitude, and behaviors regarding prevention of osteoporosis (24,29,30). The current literature suggests that successful patient education interventions relative to osteoporosis should include techniques for better patient self-management and bone health behaviors (31) and should take into consideration differences in knowledge, attitudes, and beliefs about osteoporosis between men and women (29).…”

mentioning

confidence: 99%

Barriers in the management of glucocorticoid‐induced osteoporosis

Guzman-Clark

Fang

Sehl

et al. 2007

Arthritis & Rheumatism

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Objective. To determine present practice for the management of glucocorticoid-induced osteoporosis (GIOP) in veterans; to characterize provider knowledge, beliefs, and practice behaviors regarding management of GIOP; and to identify potential barriers and interventions in the management of GIOP. Methods. To characterize current management of GIOP in an academic veterans administration medical center, we conducted a retrospective chart review of 100 patients who were prescribed a 90-day supply of prednisone. To assess clinicians' knowledge of GIOP clinical guidelines and perceptions of GIOP management, primary care clinicians and subspecialists completed a questionnaire and participated in focus groups. Results. Chart review revealed that only 32 of 100 patients receiving long-term glucocorticoid treatment underwent bone mineral density testing, and only 32 patients were prescribed the recommended calcium supplements. Of the 23 providers who completed the questionnaire and participated in the focus groups, 4 correctly identified both the dose and duration of glucocorticoid use at which GIOP prevention measures should be instituted. Common GIOP management barriers cited by participants were lack of knowledge, having limited time during the clinic visit to address all problems, patient nonadherence, and system problems. The most commonly mentioned potential interventions were the use of computerized clinical reminders and patient education. Conclusion. Clinicians frequently do not follow recommended guidelines for the management of GIOP. Improving the management of GIOP will likely require a fundamental redesigning of care processes for this disorder in order to overcome provider, patient-related, and system barriers.

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confidence: 99%

Barriers in the management of glucocorticoid‐induced osteoporosis

Guzman-Clark

Fang

Sehl

et al. 2007

Arthritis & Rheumatism

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“…Authors were contacted to verify the accuracy of reporting of these criteria in their studies -we received verification from the authors of six studies (46%) 31,34,35,[40][41][42] . We decided not to use a quality assessment scale because evidence exists that they lack empirically supported components 27 , and authors of scales can be influenced by their own perception of study quality 28 .…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…Of these, 1,246 citations were screened for relevance, 42 articles were selected for full-text review, and 13 RCTs met the inclusion/exclusion criteria and were included in the systematic review [30][31][32][33][34][35][36][37][38][39][40][41][42] …”

Section: Full-text Review Of Potentially Relevant Rcts (N = 42)mentioning

confidence: 99%

“…Table 3 shows the clinical heterogeneity across studies according to population and interventions, which also contributed to our decision not to combine results in a meta-analysis. Populations varied across studies for osteoporosis risk factors: age ≥65 years of age (six studies) 30, 33, 35, 36, 41, 42, postmenopausal women (3 studies) 34, 38, 39, previous fracture (six studies), and at least 6 months use of glucocorticoids (five studies) [40][41][42] . Differences were also found between studies for 42 ‡ Practice Done Not done Not done *Unclear = Authors did not report or provide a description for sequence generation or allocation concealment of randomization that allowed classification of "done" or "not done" †Unclear = Authors did not report or provide an indication of who, if anyone, was unaware of group assignment that allowed classification of "done" or "not done" ‡Data verified by author 42 ‡ 10 months 100% Done None Yes *Unclear = Authors did not report or provide a description for sequence generation or allocation concealment of randomization that allowed classification of "done" or "not done" †Unclear = Authors did not report or provide an indication of who, if anyone, was unaware of group assignment that allowed classification of "done" or "not done" ‡Data verified by author Of these, three studies included a reminder with or without a risk assessment strategy (Table 4) 30 -32 , and 8 studies included a reminder system plus education with or without a risk Intervention: A CME program conducted during the Phys visit by a Pharm educator, who received 1-day training on OP.…”

Section: Sources Of Heterogeneitymentioning

confidence: 99%

“…Pts received a letter and then an automated telephone call (tailored Ed) inviting them to have a BMD test, which they could schedule immediately after the call. Women age ≥65 years, women or men age ≥45 years with a prior fracture, or women or men taking glcuocorticoids for ≥90 days *GP = general practitioner; OP = osteoporosis; RA = risk assessment; Phys = physicians; Pts = patients; PCP = primary care physician; UC = usual care; BMD = bone mineral density; Ed = education; EMR = electronic medical record; SCORE = simple calculated osteoporosis risk estimation; SOF = study of osteoporotic fracture; HRT = hormone replacement therapy; GIOP = glucocorticoid-induced osteoporosis; Pharms = pharmacists; DXA = dual-energy X-ray absorptiometry; CME = continuing medical education assessment strategy (Table 5) 34-38, [40][41][42] . Two studies investigated interventions that included education with exercise or risk assessment (Table 6) 33, 39 .…”

Section: Sources Of Heterogeneitymentioning

confidence: 99%

See 2 more Smart Citations

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

Kastner

Straus

2008

J GEN INTERN MED

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Challenges in Improving the Quality of Osteoporosis Care for Long-term Glucocorticoid Users

Curtis

Westfall²,

Allison³

et al. 2007

Arch Intern Med

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Background: In light of widespread undertreatment for glucocorticoid-induced osteoporosis (GIOP), we designed a group randomized controlled trial to increase bone mineral density (BMD) testing and osteoporosis medication prescribing among patients receiving longterm glucocorticoid therapy.Methods: Using administrative databases of a large US health plan, we identified physicians who prescribed longterm glucocorticoid therapy to at least 3 patients. One hundred fifty-three participating physicians were randomized to receive a 3-module Web-based GIOP intervention or control course. Intervention modules focused on GIOP management and incorporated case-based continuing medical education and personalized audit and feedback of GIOP management compared with that of the top 10% of study physicians. In the year following the intervention, we compared rates of BMD testing and osteoporosis medication prescribing between intervention and control physicians.Results: Following the intervention, intent-to-treat analyses showed that 78 intervention physicians (472 patients) vs 75 control physicians (477 patients) had simi-lar rates of BMD testing (19% vs 21%, P = .48; rate difference, −2%; 95% confidence interval [CI], −8% to 4%) and osteoporosis medication prescribing (32% vs 29%, P=.34; rate difference, 3%; 95% CI, −3% to 9%). Among 45 physicians completing all modules (343 patients), intervention physicians had numerically but not significantly higher rates of BMD testing (26% vs 16%, P =.04; rate difference, 10%; 95% CI, 1%-20%) and bisphosphonate prescribing (24% vs 17%, P=.09; rate difference, 7%; 95% CI, −1% to 16%) or met a combined end point of BMD testing or osteoporosis medication prescribing (54% vs 44%, P =.07; rate difference, 10%; 95% CI, −1% to 21%) compared with control physicians. Conclusions:In the main analysis, a Web-based intervention incorporating performance audit and feedback and case-based continuing medical education had no significant effect on the quality of osteoporosis care. However, dose-response trends showed that physicians with greater exposure to the intervention had higher rates of GIOP management. New cost-effective modalities are needed to improve the quality of osteoporosis care.

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A randomized controlled trial of mailed osteoporosis education to older adults

Cited by 64 publications

References 14 publications

Barriers in the management of glucocorticoid‐induced osteoporosis

Barriers in the management of glucocorticoid‐induced osteoporosis

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

Challenges in Improving the Quality of Osteoporosis Care for Long-term Glucocorticoid Users

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