Redesigning care to improve detection and treatment of osteoporosis

The objective of a recent study [1] was to determine whether a process redesign could improve detection and treatment of osteoporosis in at-risk women over the age of 65 through increased BMD testing, and to determine if a shared medical appointment (SMA) improved treatment for high-risk women. Two primary care sites received the redesign intervention and two other sites served as the usual-care controls. At the intervention sites, all women 65 who had not had a DXA scan performed in the prior 2 years were contacted by mail and phone calls. High-risk patients were invited to attend a SMA or follow-up visit with their primary physician.

A significantly higher proportion of women at the intervention sites had a DXA (39.6% vs 13.2%, P<0.0001). Patients who attended the SMA were more likely to have calcium and vitamin D recommended, a vitamin D level checked, and receive a prescription medicine than those patients who had follow-up with their primary care physician.

It is concluded that the redesigned process was highly effective in improving BMD testing for women 65. The SMA was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared with usual care with the primary care physician.

1. Ayoub WT et al. Osteoporos Int. 2009;20: 37–42.

Introduction SMA versus PCP