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

Academic Article

Abstract

  • 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.
  • Published In

  • Medical Care  Journal
  • Keywords

  • Absorptiometry, Photon, Age Factors, Aged, Aged, 80 and over, Bone Density, Comorbidity, Continental Population Groups, Diagnostic Self Evaluation, Female, Humans, Mass Screening, Osteoporosis, Patient Education as Topic
  • Digital Object Identifier (doi)

    Author List

  • Warriner AH; Outman RC; Feldstein AC; Roblin DW; Allison JJ; Curtis JR; Redden DT; Rix MM; Robinson BE; Rosales AG
  • Start Page

  • 743
  • End Page

  • 750
  • Volume

  • 52
  • Issue

  • 8