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Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users: a prospective randomized trial
Quantitative Health Sciences Publications and Presentations
  • Jeffrey R. Curtis, University of Alabama
  • Andrew O. Westfall, University of Alabama
  • Jeroan J. Allison, University of Massachusetts Medical School
  • Angela Becker, University of Alabama
  • Mary Elkins Melton, University of Alabama
  • Allison Freeman
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Marilyn MacArthur
  • Theresa Ockershausen
  • Emily Stewart, University of Alabama
  • Norman Weissman, University of Alabama
  • Kenneth G. Saag, University of Alabama
UMMS Affiliation
Department of Quantitative Health Sciences
Date
3-29-2007
Document Type
Article
Medical Subject Headings
Adrenal Cortex Hormones; Bone Density; *Computer-Assisted Instruction; Databases as Topic; Diphosphonates; Drug Utilization; *Education, Medical; Female; Humans; Male; Mass Screening; Middle Aged; Osteoporosis; Physician's Practice Patterns; Prospective Studies; United States
Abstract

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.

Rights and Permissions
Citation: Arch Intern Med. 2007 Mar 26;167(6):591-6. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
Jeffrey R. Curtis, Andrew O. Westfall, Jeroan J. Allison, Angela Becker, et al.. "Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users: a prospective randomized trial" Vol. 167 Iss. 6 (2007) ISSN: 0003-9926 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/169/