Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial

Stephanie W Edmonds, Peter Cram, Yiyue Lou, Michael P Jones, Douglas W Roblin, Kenneth G Saag, Nicole C Wright, Fredric D Wolinsky, PAADRN Investigators, JeffreyR Curtis, SarahL Morgan, JanetA Schlechte, DavidJ Zelman, Stephanie W Edmonds, Peter Cram, Yiyue Lou, Michael P Jones, Douglas W Roblin, Kenneth G Saag, Nicole C Wright, Fredric D Wolinsky, PAADRN Investigators, JeffreyR Curtis, SarahL Morgan, JanetA Schlechte, DavidJ Zelman

Abstract

Background: Undiagnosed, or diagnosed and untreated osteoporosis (OP) increases the likelihood that falls result in hip fractures, decreased quality of life (QOL), and significant medical expenditures among older adults. We tested whether a tailored dual energy x-ray absorptiometry (DXA) test result letter and an accompanying educational bone-health brochure affected patient satisfaction, QOL, or OP knowledge.

Methods: The Patient Activation after DXA Result Notification (PAADRN) study was a double-blinded, pragmatic, randomized trial which enrolled patients from 2012 to 2014. We randomized 7,749 patients presenting for DXA at three health care institutions in the United States who were ≥ 50 years old and able to understand English. Intervention patients received a tailored letter four weeks after DXA containing their results, 10-year fracture risk, and a bone-health educational brochure. Control patients received the results of their DXA per the usual practices of their providers and institutions. Satisfaction with bone health care, QOL, and OP knowledge were assessed at baseline and 12- and 52-weeks after DXA. Intention-to-treat analyses used multiple imputation for missing data and random effects regression models to adjust for clustering within providers and covariates.

Results: At 12-weeks 6,728 (86.8 %) and at 52-weeks 6,103 participants (78.8 %) completed their follow-up interviews. The intervention group was more satisfied with their bone health care compared to the usual care group at both their 12- and 52-week follow-ups (standardized effect size = 0.28 at 12-weeks and 0.17 at 52-weeks, p < 0.001). There were no differences between the intervention and usual care groups in QOL or OP knowledge at either time point.

Conclusions: A tailored DXA result letter and bone-health educational brochure sent to patients improved patient satisfaction with bone-related health care.

Trial registration: Clinical Trials.gov Identifier: NCT01507662 First received: December 8, 2011.

Keywords: Dual-energy x-ray absorptiometry; Health education; Osteoporosis; Quality of health care; Quality of life.

Figures

Fig. 1
Fig. 1
CONSORT Flow Diagram of PAADRN Study

References

    1. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–2526. doi: 10.1002/jbmr.2269.
    1. US Department of Health and Human Services . Office of the Surgeon General. Rockville: US Department of Health and Human Services; 2004. Bone health and osteoporosis: a report of the Surgeon General.
    1. Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87(3):398–403. doi: 10.2105/AJPH.87.3.398.
    1. Doheny MO, Sedlak CA, Estok PJ, Zeller R. Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthop Nurs. 2007;26(4):243–250. doi: 10.1097/.
    1. Cadarette SM, Gignac MA, Beaton DE, Jaglal SB, Hawker GA. Psychometric properties of the “Osteoporosis and You” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporos Int. 2007;18(7):981–989. doi: 10.1007/s00198-007-0326-z.
    1. Bandura A. Social foundations of thought and action. Englewood Cliffs, NJ: Prentice-Hall; 1986.
    1. Babatunde OT, Himburg SP, Newman FL, Campa A, Dixon Z. Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults. J Nutr Educ Behav. 2011;43(6):434–440. doi: 10.1016/j.jneb.2010.07.004.
    1. Schulman JE, Williams S, Khera O, Sahba T, Michelson J, Fine K. Effective osteoporosis education in the outpatient orthopaedic setting. J Bone Joint Surg Am. 2007;89(2):301–306. doi: 10.2106/JBJS.F.00491.
    1. Kulp JL, Rane S, Bachmann G. Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up. Menopause (New York, NY) 2004;11(1):116–119. doi: 10.1097/01.GME.0000079221.19081.11.
    1. Qi BB, Resnick B, Smeltzer SC, Bausell B. Self-efficacy program to prevent osteoporosis among Chinese immigrants: a randomized controlled trial. Nurs Res. 2011;60(6):393–404. doi: 10.1097/NNR.0b013e3182337dc3.
    1. Majumdar SR, McAlister FA, Johnson JA, Weir DL, Bellerose D, Hanley DA, Russell AS, Rowe BH. Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from two controlled trials. Osteoporos Int. 2014;25(9):2173–2179. doi: 10.1007/s00198-014-2728-z.
    1. Oh EG, Yoo JY, Lee JE, Hyun SS, Ko IS, Chu SH. Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial. Res Nurs Health. 2014;37(4):292–301. doi: 10.1002/nur.21608.
    1. Wu F, Laslett LL, Wills K, Oldenburg B, Jones G, Winzenberg T. Effects of individualized bone density feedback and educational interventions on osteoporosis knowledge and self-efficacy: a 12-years prospective study. J Clin Densitom. 2014;17(4):466–472. doi: 10.1016/j.jocd.2014.07.008.
    1. Montori VM, Shah ND, Pencille LJ, Branda ME, Van Houten HK, Swiglo BA, Kesman RL, Tulledge-Scheitel SM, Jaeger TM, Johnson RE, et al. Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial. Am J Med. 2011;124(6):549–556. doi: 10.1016/j.amjmed.2011.01.013.
    1. Francis KL, Matthews BL, Van Mechelen W, Bennell KL, Osborne RH. Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial. Osteoporos Int. 2009;20(9):1563–1570. doi: 10.1007/s00198-009-0834-0.
    1. Lai PS, Chua SS, Chan SP. Impact of pharmaceutical care on knowledge, quality of life and satisfaction of postmenopausal women with osteoporosis. Int J Clin Pharm. 2013;35(4):629–637. doi: 10.1007/s11096-013-9784-x.
    1. Cram P, Rosenthal GE, Ohsfeldt R, Wallace RB, Schlechte J, Schiff GD. Failure to recognize and act on abnormal test results: the case of screening bone densitometry. Jt Comm J Qual Patient Saf. 2005;31(2):90–97.
    1. Shibli-Rahhal A, Vaughan-Sarrazin MS, Richardson K, Cram P. Testing and treatment for osteoporosis following hip fracture in an integrated U.S. healthcare delivery system. Osteoporos Int. 2011;22(12):2973–2980. doi: 10.1007/s00198-011-1536-y.
    1. Waalen J, Bruning AL, Peters MJ, Blau EM. A telephone-based intervention for increasing the use of osteoporosis medication: a randomized controlled trial. Am J Manag Care. 2009;15(8):e60–e70.
    1. Cram P, Schlechte J, Christensen A. A randomized trial to assess the impact of direct reporting of DXA scan results to patients on quality of osteoporosis care. J Clin Densitom. 2006;9(4):393–398. doi: 10.1016/j.jocd.2006.09.002.
    1. Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007;133(4):673–693. doi: 10.1037/0033-2909.133.4.673.
    1. Ryan P, Lauver DR. The efficacy of tailored interventions. J Nurs Scholarsh. 2002;34(4):331–337. doi: 10.1111/j.1547-5069.2002.00331.x.
    1. Cram P, Schlechte J, Rosenthal GE, Christensen AJ. Patient preference for being informed of their DXA scan results. J Clin Densitom. 2004;7(3):275–280. doi: 10.1385/JCD:7:3:275.
    1. Edmonds SW, Wolinsky FD, Christensen AJ, Lu X, Jones MP, Roblin DW, Saag KG, Cram P. The PAADRN Study: A design for a randomized controlled practical clinical trial to improve bone health. Contemp Clin Trials. 2013;34(1):90–100. doi: 10.1016/j.cct.2012.10.002.
    1. R Core Team . R Foundation for Statistical Computing. Vienna: R Development Core Team; 2015. A language and environment for statistical computing.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Edmonds SW, Solimeo SL, Lu X, Roblin DW, Saag KG, Cram P. Developing a bone mineral density test result letter to send to patients: a mixed-methods study. Patient Preference Adherence. 2014;8:827–841. doi: 10.2147/PPA.S60106.
    1. Edmonds SW, Cram P, Lu X, Roblin DW, Wright NC, Saag KG, Solimeo SL. Improving bone mineral density reporting to patients with an illustration of personal fracture risk. BMC Med Inform Decis Mak. 2014;14:101. doi: 10.1186/s12911-014-0101-y.
    1. Diehr P, Patrick DL, Spertus J, Kiefe CI, McDonell M, Fihn SD. Transforming self-rated health and the SF-36 scales to include death and improve interpretability. Med Care. 2001;39(7):670–680. doi: 10.1097/00005650-200107000-00004.
    1. Euroqol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy (Amsterdam, Netherlands). 1990;16(3):199-208.
    1. Brooks R. EuroQol: the current state of play. Health policy (Amsterdam, Netherlands) 1996;37(1):53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Brenneman SK, Blau EM, Chen Y, Abbott TA. Validation of a patient questionnaire, 'Osteoporosis and You', designed to assess osteoporosis-related attitudes, knowledge and behavior. J Bone Miner Res. 2002;17(Suppl 1):S466.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–592.
    1. Krantz DS, Baum A, Wideman M. Assessment of Preferences for self-treatment and information in health care. J Pers Soc Psychol. 1980;39(5):977–990. doi: 10.1037/0022-3514.39.5.977.
    1. Epstein RM, Street RL., Jr The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100–103. doi: 10.1370/afm.1239.
    1. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Project Hope) 2013;32(2):207–214. doi: 10.1377/hlthaff.2012.1061.
    1. HCAHPS: Patients’ Perspectives of Care Survey []. Accessed 23 July 2015.
    1. Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT. Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial. Osteoporos Int. 2010;21(3):391–398. doi: 10.1007/s00198-009-0977-z.
    1. Nunnally JC. Psychometric theory. 2. New York, NY: McGraw-Hill; 1978.
    1. Kim KK, Horan ML, Gendler P. Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, and Osteoporosis Self-Efficacy Scale. Allendale, MI: Grand Valley State University; 1991.
    1. Pande KC, de Takats D, Kanis JA, Edwards V, Slade P, McCloskey EV. Development of a questionnaire (OPQ) to assess patient's knowledge about osteoporosis. Maturitas. 2000;37(2):75–81. doi: 10.1016/S0378-5122(00)00165-1.
    1. Winzenberg TM, Oldenburg B, Frendin S, Jones G. The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the Osteoporosis Knowledge Assessment Tool (OKAT) BMC Musculoskelet Disord. 2003;4:17. doi: 10.1186/1471-2474-4-17.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa