Challenges in Improving the Quality of Osteoporosis Care for Long-term Glucocorticoid Users
| Autor: | Catarina I. Kiefe, Norman W. Weissman, Emily Stewart, Jeffrey R. Curtis, Kenneth G. Saag, Andrew O. Westfall, Mary Elkins Melton, Angela Becker, Allison Freeman, Theresa Ockershausen, Marilyn MacArthur, Jeroan J. Allison |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Bone density medicine.medical_treatment Osteoporosis law.invention Randomized controlled trial Continuing medical education Adrenal Cortex Hormones Bone Density law Internal medicine Internal Medicine medicine Humans Mass Screening Prospective Studies Practice Patterns Physicians' Prospective cohort study Diphosphonates Education Medical business.industry Middle Aged Bisphosphonate medicine.disease Drug Utilization United States Confidence interval Clinical trial Databases as Topic Physical therapy Female business Computer-Assisted Instruction |
| Zdroj: | Archives of Internal Medicine. 167:591 |
| ISSN: | 0003-9926 |
| Popis: | 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 long-term glucocorticoid therapy. Methods Using administrative databases of a large US health plan, we identified physicians who prescribed long-term 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 similar 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. |
| Databáze: | OpenAIRE |
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