Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial

Fredric D Wolinsky; Yiyue Lou; Stephanie W Edmonds; Sylvie F Hall; Michael P Jones; Nicole C Wright; Kenneth G Saag; Peter Cram; Douglas W Roblin

doi:10.1016/j.jocd.2016.08.012

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Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial

Journal article

Peer reviewed

Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial

Fredric D Wolinsky, Yiyue Lou, Stephanie W Edmonds, Sylvie F Hall, Michael P Jones, Nicole C Wright, Kenneth G Saag, Peter Cram and Douglas W Roblin

Journal of clinical densitometry, Vol.20(4), pp.464-471

10/2017

DOI: 10.1016/j.jocd.2016.08.012

PMCID: PMC5354993

PMID: 27647261

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Abstract

In cross-sectional studies, patient activation has been associated with better health behaviors, health outcomes, and health-care experiences. Moreover, tailored interventions have led to clinically meaningful improvements in patient activation, as well as health outcomes over time. We tested whether a tailored patient-activation letter communicating bone mineral density (BMD) test results plus an educational brochure improved patient activation scores and levels at 12 and 52 wk post-baseline as the mechanism leading to enhanced bone healthcare. In a randomized, controlled, double-blinded, multicenter pragmatic clinical trial, we randomized 7749 patients ≥50 yr old and presenting for BMD testing at 3 medical centers in the United States between February 2012 and August 2014. The outcome measures were patient activation scores and levels based on 6 items taken from the Patient Activation Measure (PAM) that were administered at the baseline, 12-wk, and 52-wk follow-up interviews. Mean age was 66.6 yr, 83.8% were women, and 75.3% were Non-Hispanic-Whites. Overall, PAM activation scores improved from 58.1 at baseline to 76.4 by 12 wk (p < 0.001) and to 77.2 (p = 0.002) by 52 wk post-baseline. These improvements, however, were not significantly different between the intervention and usual care groups (18.7 vs 18.1, p = 0.176, at 12 wk) in intention-to-treat analyses. PAM activation scores and levels substantially improved at 12 wk and 52 wk, but no differences were observed in these improvements between the intervention and usual care groups. These null findings may have occurred because the tailoring focused on the patient's BMD and fracture risk results, rather than on the patient's BMD and fracture risk results as well as the patient's baseline PAM activation scores or levels.

Osteoporosis

clinical trial

patient activation

Bone density testing

Details

Title: Subtitle: Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial
Creators: Fredric D Wolinsky - Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
Yiyue Lou - Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
Stephanie W Edmonds - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Sylvie F Hall - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Michael P Jones - Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
Nicole C Wright - Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
Kenneth G Saag - Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
Peter Cram - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Douglas W Roblin - Kaiser Permanente of Georgia, Atlanta, GA, USA
Contributors: PAADRN Investigators (Contributor)
Resource Type: Journal article
Publication Details: Journal of clinical densitometry, Vol.20(4), pp.464-471
DOI: 10.1016/j.jocd.2016.08.012
PMID: 27647261
PMCID: PMC5354993
NLM abbreviation: J Clin Densitom
ISSN: 1094-6950
eISSN: 1559-0747
Publisher: Elsevier Inc
Grant note: name: NIA, award: R01 AG033035; DOI: 10.13039/100000069, name: NIAMS, award: K24 AR062133, K24 AR052361
Language: English
Date published: 10/2017
Academic Unit: Statistics and Actuarial Science; Health Management and Policy; Biostatistics; Nursing; Public Policy Center (Archive); Internal Medicine
Record Identifier: 9983985968202771

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