Effect of self-referral on bone mineral density testing and osteoporosis treatment
Department of Quantitative Health Sciences
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
Community Health and Preventive Medicine | Health Services Research | Musculoskeletal Diseases | Public Health Education and Promotion | Women's Health
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.
DOI of Published Version
Med Care. 2014 Aug;52(8):743-50. doi: 10.1097/MLR.0000000000000170. Link to article on publisher's site
Warriner AH, Outman RC, Feldstein AC, Roblin DW, Allison JJ, Curtis JR, Redden DT, Rix MM, Robinson BE, Rosales AG, Safford MM, Saag KG. (2014). Effect of self-referral on bone mineral density testing and osteoporosis treatment. UMass Chan Medical School Faculty Publications. https://doi.org/10.1097/MLR.0000000000000170. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/689