Effect of self-referral on bone mineral density testing and osteoporosis treatment
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عنوان: Effect of self-referral on bone mineral density testing and osteoporosis treatment
نویسندگان:
Warriner AH1, Outman RC, Feldstein AC, Roblin DW, Allison JJ, Curtis JR, Redden DT, Rix MM, Robinson BE, Rosales AG, Safford MM, Saag KG.
1: Divisions of *Endocrinology, Diabetes and Metabolism †Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL ‡Kaiser Permanente Center for Health Research/Northwest, Portland, OR §Kaiser Permanente Center for Health Research/Southeast, Atlanta, GA ∥Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA Division of Clinical Immunology and Rheumatology #Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL.
نشریه: Medical care
انتشارات: Wolters Kluwer Health | Lippincott Williams & Wilkins
تاریخ انتشار: 2014-08-01
کد مقاله: 01060606
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چکیده:
BACKGROUND:
Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening.
OBJECTIVE:
To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing andosteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral).
RESEARCH DESIGN:
Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG).
SUBJECTS:
Women aged 65 years and older without a DXA in past 5 years.
MEASURES:
DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing.
RESULTS:
From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0%-24.1%self-referral vs. 4.9%-5.9% UC, P<0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared with UC (P<0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8%-3.4%) but significantly greater amongself-referral versus UC in KPNW.
CONCLUSIONS:
DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.
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