Journal article
Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial
Osteoporosis International, Vol.27(12), pp.3513-3524
12/2016
DOI: 10.1007/s00198-016-3681-9
PMCID: PMC5572571
PMID: 27363400
Abstract
Patients often do not know or understand their bone density test results, and pharmacological treatment rates are low. In a clinical trial of 7749 patients, we used a tailored patient-activation result letter accompanied by a bone health brochure to improve appropriate pharmacological treatment. Treatment rates, however, did not improve.Patients often do not know or understand their dual-energy x-ray absorptiometry (DXA) test results, which may lead to suboptimal care. We tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline-concordant pharmacological treatment compared to usual care only.We conducted a randomized, controlled, double-blinded, pragmatic clinical trial at three health care centers in the USA. We randomized 7749 patients ≥50 years old and presenting for DXA between February 2012 and August 2014. The primary clinical endpoint at 12 and 52 weeks post-DXA was receiving guideline-concordant pharmacological treatment. We also examined four of the steps along the pathway from DXA testing to that clinical endpoint, including (1) receiving and (2) understanding their DXA results and (3) having subsequent contact with their provider and (4) discussing their results and options.Mean age was 66.6 years, 83.8 % were women, and 75.3 % were non-Hispanic whites. Intention-to-treat analyses revealed that guideline-concordant pharmacological treatment was not improved at either 12 weeks (65.1 vs. 64.3 %, p = 0.506) or 52 weeks (65.2 vs. 63.8 %, p = 0.250) post-DXA, even though patients in the intervention group were more likely (all p < 0.001) to recall receiving their DXA results letter at 12 weeks, correctly identify their results at 12 and 52 weeks, have contact with their provider at 52 weeks, and have discussed their results with their provider at 12 and 52 weeks.A tailored DXA result letter and educational brochure failed to improve guideline-concordant care in patients who received DXA.
Details
- Title: Subtitle
- Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial
- Creators
- P Cram - University of Iowa, Internal MedicineF Wolinsky - The University of Iowa 145 North Riverside Drive, CPHB N211 Iowa City IA 52242 USAY Lou - Department of Biostatistics University of Iowa College of Public Health Iowa City IA USAS W Edmonds - University of Iowa College of Nursing Iowa City IA USAS F Hall - Division of General Internal Medicine, Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City IA USAD W Roblin - School of Public Health Georgia State University Atlanta GA USAN C Wright - Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham Birmingham AL USAM P Jones - Department of Biostatistics University of Iowa College of Public Health Iowa City IA USAK G Saag - Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham Birmingham AL USA
- Contributors
- PAADRN Investigators (Author)
- Resource Type
- Journal article
- Publication Details
- Osteoporosis International, Vol.27(12), pp.3513-3524
- DOI
- 10.1007/s00198-016-3681-9
- PMID
- 27363400
- PMCID
- PMC5572571
- NLM abbreviation
- Osteoporos Int
- ISSN
- 0937-941X
- eISSN
- 1433-2965
- Publisher
- Springer London; London
- Grant note
- K24 AR052361 / National Institute for Arthritis and Musculoskeltal Diseases K24 AR062133 / National Institute for Arthritis and Musculoskelatal Diseases R01 AG033035 / National Institute on Aging (http://dx.doi.org/10.13039/100000049)
- Language
- English
- Date published
- 12/2016
- Academic Unit
- Statistics and Actuarial Science; Health Management and Policy; Biostatistics; Nursing; Public Policy Center (Archive); Internal Medicine
- Record Identifier
- 9983985715102771
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