Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

Abstract

BackgroundUndiagnosed, or diagnosed and untreated osteoporosis (OP) increases the likelihood that falls result in hip fractures, decreased quality of life (QOL), and significant medical expenditures among older adults. We tested whether a tailored dual energy x-ray absorptiometry (DXA) test result letter and an accompanying educational bone-health brochure affected patient satisfaction, QOL, or OP knowledge.MethodsThe Patient Activation after DXA Result Notification (PAADRN) study was a double-blinded, pragmatic, randomized trial which enrolled patients from 2012 to 2014. We randomized 7,749 patients presenting for DXA at three health care institutions in the United States who were ≥ 50 years old and able to understand English. Intervention patients received a tailored letter four weeks after DXA containing their results, 10-year fracture risk, and a bone-health educational brochure. Control patients received the results of their DXA per the usual practices of their providers and institutions. Satisfaction with bone health care, QOL, and OP knowledge were assessed at baseline and 12- and 52-weeks after DXA. Intention-to-treat analyses used multiple imputation for missing data and random effects regression models to adjust for clustering within providers and covariates.ResultsAt 12-weeks 6,728 (86.8 %) and at 52-weeks 6,103 participants (78.8 %) completed their follow-up interviews. The intervention group was more satisfied with their bone health care compared to the usual care group at both their 12- and 52-week follow-ups (standardized effect size = 0.28 at 12-weeks and 0.17 at 52-weeks, p < 0.001). There were no differences between the intervention and usual care groups in QOL or OP knowledge at either time point.ConclusionsA tailored DXA result letter and bone-health educational brochure sent to patients improved patient satisfaction with bone-related health care.Trial registrationClinical Trials.gov Identifier: NCT01507662 First received: December 8, 2011.

The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial

“…Between February 2012 and August 2014 we identified patients potentially eligible to participate in the PAADRN pragmatic RCT by reviewing the electronic scheduling records for DXA testing appointments of patients referred to DXA testing at the University of Iowa (UI), the University of Alabama at Birmingham (UAB), and Kaiser Permanente of Georgia (KPGA) by their providers [13–15]. These three sites were chosen because of the diversity of their academic affiliations, osteoporosis research and clinical programs, geographic locations, and patient populations served.…”

“…Intervention patients were notified of their DXA results via an individually tailored letter accompanied by an educational brochure [13–15, 19, 20]. The letter included the clinical impression of each patient’s DXA result (normal, osteopenia, or osteoporosis), their 10-year fracture risk, and the suggestion that the patient bring the letter to their next physician visit and discuss it with their provider.…”

“…To increase rates of guideline-concordant pharmacotherapy, proper calcium and vitamin D intake, weight-bearing and muscle-strengthening exercise, osteoporosis knowledge, care satisfaction, and health-related quality of life, we conducted the Patient Activation after DXA Result Notification (PAADRN; NCT-01507662) trial, a pragmatic randomized controlled trial (RCT) [13–15]. We enrolled 7749 patients presenting for DXA testing at three U.S. health care centers.…”

Validity, reliability, and responsiveness to change of the “Osteoporosis and You” knowledge scale

“…Because PAADRN included both men and women, however, we modified item 2 to read “For women, the risk of having osteoporosis is higher after menopause;” additionally, “father” was added to item 3 and “man” was included in items 7 and 8 [22, 23]. Similar to Cadarette et al, items were scored as correct for true statements when the participant chose the “agree” or “strongly agree” response options while reverse-scored items 6 and 9 were scored as correct when the participant chose “disagree” or “strongly disagree.” In constructing the overall and domain-specific scale scores, the percentage of correct answers was used.…”

Evaluation of a “Just-in-Time” Nurse Consultation on Bone Health: A Pilot Randomized Controlled Trial

“…The PAADRN intervention-a timely, tailored, direct-to-patient letter with personal fracture risk information and an educational brochureappears to be particularly potent in improving osteoporosis care satisfaction compared with usual care. 41 On other outcomes (eg, guideline-concordant pharmacotherapy, total calcium Vitamin D supplementation, frequency of weightbearing and strengthening exercise), the PAADRN intervention was typically marginally better than usual care over a 52-week period. 27,42 Two other integrated delivery systems that conducted RCTs of similar nurse consultations found somewhat more encouraging results.…”