Effect of self-referral on bone mineral density testing and osteoporosis treatment

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dc.contributor.authorWarriner, Amy H.
dc.contributor.authorOutman, Ryan C.
dc.contributor.authorFeldstein, Adrianne C.
dc.contributor.authorRoblin, Douglas W.
dc.contributor.authorAllison, Jeroan J.
dc.contributor.authorCurtis, Jeffrey R.
dc.contributor.authorRedden, David T.
dc.contributor.authorRix, Mary M.
dc.contributor.authorRobinson, Brandi E.
dc.contributor.authorRosales, Ana G.
dc.contributor.authorSafford, Monika M.
dc.contributor.authorSaag, Kenneth G.
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.date2022-08-11T08:08:32.000
dc.date.accessioned2022-08-23T15:58:21Z
dc.date.available2022-08-23T15:58:21Z
dc.date.issued2014-08-01
dc.date.submitted2015-07-31
dc.description.abstractBACKGROUND: 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 and osteoporosis 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 among self-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.
dc.identifier.citationMed Care. 2014 Aug;52(8):743-50. doi: 10.1097/MLR.0000000000000170. <a href="http://dx.doi.org/10.1097/MLR.0000000000000170">Link to article on publisher's site</a>
dc.identifier.contextkey7396534
dc.identifier.doi10.1097/MLR.0000000000000170
dc.identifier.issn0025-7079 (Linking)
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/689
dc.identifier.pmid24984211
dc.identifier.submissionpathfaculty_pubs/689
dc.identifier.urihttps://hdl.handle.net/20.500.14038/30413
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=24984211&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101066/
dc.source.issue8
dc.source.journaltitleMedical care
dc.source.pages743-50
dc.source.volume52
dc.subjectAbsorptiometry, Photon
dc.subjectAge Factors
dc.subjectAged
dc.subjectAged, 80 and over
dc.subject*Bone Density
dc.subjectComorbidity
dc.subjectContinental Population Groups
dc.subject*Diagnostic Self Evaluation
dc.subjectFemale
dc.subjectHumans
dc.subjectMass Screening
dc.subjectOsteoporosis
dc.subjectPatient Education as Topic
dc.subjectCommunity Health and Preventive Medicine
dc.subjectHealth Services Research
dc.subjectMusculoskeletal Diseases
dc.subjectPublic Health Education and Promotion
dc.subjectWomen's Health
dc.titleEffect of self-referral on bone mineral density testing and osteoporosis treatment
dc.typeJournal Article
dspace.entity.typePublication
html.description.abstract<p>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.</p> <p>OBJECTIVE: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis 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).</p> <p>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.</p> <p>MEASURES: DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing.</p> <p>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 among self-referral versus UC in KPNW.</p> <p>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.</p>
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