Effect of self-referral on bone mineral density testing and osteoporosis treatment
Authors
Warriner, Amy H.Outman, Ryan C.
Feldstein, Adrianne C.
Roblin, Douglas W.
Allison, Jeroan J.
Curtis, Jeffrey R.
Redden, David T.
Rix, Mary M.
Robinson, Brandi E.
Rosales, Ana G.
Safford, Monika M.
Saag, Kenneth G.
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2014-08-01Keywords
Absorptiometry, PhotonAge Factors
Aged
Aged, 80 and over
*Bone Density
Comorbidity
Continental Population Groups
*Diagnostic Self Evaluation
Female
Humans
Mass Screening
Osteoporosis
Patient Education as Topic
Community Health and Preventive Medicine
Health Services Research
Musculoskeletal Diseases
Public Health Education and Promotion
Women's Health
Metadata
Show full item recordAbstract
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 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.Source
Med Care. 2014 Aug;52(8):743-50. doi: 10.1097/MLR.0000000000000170. Link to article on publisher's siteDOI
10.1097/MLR.0000000000000170Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30413PubMed ID
24984211Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/MLR.0000000000000170