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Tajani S, Towle A, Beamish L, Bluman B. Patient Partners in Continuing Professional Development: Experience Developing an End-of-Life Care Program for Family Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:273-278. [PMID: 34609354 DOI: 10.1097/ceh.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Involvement of patients in continuing professional development (CPD) is less developed than in health professional education at undergraduate or postgraduate levels. Although patients are sometimes involved in delivering CPD, they are less likely to be involved in education planning. At our institution, patients have sometimes acted as consultants in the design of CPD. The problem we address is how to engage patients as partners throughout the design process. We applied principles of authentic patient engagement and lessons learned from patient involvement in undergraduate health professional education to the design of CPD for family physicians. We created a partnership between the CPD Office and Patient and Community Partnership for Education, a unit with a history of patient involvement in the education of health professional students. Practices for meaningful involvement were identified through literature review, environmental scan, and interviewing key informants, including patients involved in health professional education at the university. These principles and practices were applied to the development of a CPD module on end-of-life care. Patient partners contributed new perspectives and some CPD providers reassessed components of their own practice as a result. Lessons learned include the need for stakeholder buy-in; mechanisms to identify those patients best able to contribute expertise; ways to facilitate involvement that work for both patients and CPD providers; the importance of feedback mechanisms to patient partners; and recognition for patient contributions. CPD offices should view integration of patient partners in program planning as an opportunity to engage in ongoing quality improvement.
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Affiliation(s)
- Sarah Tajani
- Ms. Tajani: Learning & Curriculum Manager, Division of Continuing Professional Development, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Dr. Towle: Co-Director Patient & Community Partnership for Education, Office of UBC Health & Associate Professor, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Ms. Beamish: Senior Manager, Rural CPD, Division of Continuing Professional Development, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Dr. Bluman: Executive Medical Director, Continuing Professional Development & Clinical Professor, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Liederman Z, Quartey NK, Ward R, Papadakos J. Exploration of Barriers and Facilitators to Optimal Emergency Department Care of Sickle Cell Disease: Opportunities for Patient-Physician Partnerships to Improve Care. Hemoglobin 2020; 45:13-19. [PMID: 33327819 DOI: 10.1080/03630269.2020.1859383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sickle cell disease patients commonly present to an emergency department (ED) due to acute vaso-occlusive pain episodes (VOEs), also known as vaso-occlusive crises (VOCs). Unsatisfactory patient care leads to preventable morbidity, mortality, and substantial financial costs. This study investigated the current use of sickle cell disease patient-directed physician education (PDPE) in the clinical setting and also explored opportunities for improvement. A qualitative phenomenologic design was used with semi-structured in-depth interviews. Open-ended questions were used to probe participant's experiences with EDs, the feasibility of a PDPE program as well as barriers and facilitators to PDPE. A total of nine patients and eight physicians participated in the study. Three major themes were identified: divergent challenges to patient recommendations, new targets for sickle cell disease education and triage process: not heard and not seen. Numerous challenges exist to the implementation and optimization of PDPE with sickle cell disease triage processes and nursing support identified as influential factors. Paramount to the process of improving PDPE is physicians perceiving patients as credible sources of information, especially as it relates to generalized concerns of opioid dosing. A patient provided written or digital education tool can be considered to facilitate PDPE to ease communication strain on patients while increasing communication efficiency.
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Affiliation(s)
- Zachary Liederman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Haematology, University Health Network, Toronto, ON, Canada
| | - Naa Kwarley Quartey
- Department of Cancer Education, Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Richard Ward
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Haematology, University Health Network, Toronto, ON, Canada
| | - Janet Papadakos
- Department of Cancer Education, Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Patient Education, Toronto, ON, Canada.,Department of Health Services Research, Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Abstract
Evidence-based medicine (EBM) has been advocated as one of the central dogmas of health care since the late 20th century. EBM provides health care entities the prospect to revolutionize health care practices and improve the standard of health care for everyone. Therefore, the potential benefits for adopting EBM practices cannot be overlooked. However, physicians face an increasingly difficult challenge, both personal and professional, when adopting EBM practices. Therefore, knowledge of effective strategies for driving physician behavioral is necessary. To this effort, this systematic review is tasked to compile and analyze the literature focused on physician behavior change. After a review of 1970 studies, 29 different studies were meticulously evaluated by 2 separate reviewers. Studies were then categorized into 5 broad distinctions based on their assessed outcomes: (1) physician knowledge; (2) ordering of tests; (3) compliance with protocols; (4) prescription of medications; and (5) complication rates. The testing group was focused on osteoporosis screening, using educational interventions. Protocol compliance studies were heterogeneous, ranging from diagnosing supracondylar fractures in pediatric patients to antimicrobial administration. Prescription pattern studies were primarily focused around the management of osteoporosis. Multimodal interventions seemed to be more effective when producing change. However, due to the variability in intervention type and outcomes assessment, it is difficult to conclude the most effective intervention for driving physician behavioral change. Physician behavior and specifically surgeon behavior are disproportionately influenced by mentors, fellowship training, and memories of excellent or catastrophic outcomes much more so than literature and data. Adopting evidence-based practices (EBM) and value centric care may provide an opportunity for physicians to improve personal performance.
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Constantine RJ, McPherson MA, Jones ME, Tandon R, Becker ER. Improving psychotherapeutic medication prescribing in Florida: implementation of the Florida Medicaid Drug Therapy Management Program (MDTMP). Community Ment Health J 2013; 49:33-44. [PMID: 22383046 DOI: 10.1007/s10597-012-9497-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 01/18/2012] [Indexed: 10/28/2022]
Abstract
This paper describes a program that was established by Florida Medicaid to improve the quality of prescribing of psychotherapeutic medications. It relates the process used for defining quality medication treatment including the definitions of unusual psychotherapeutic medication indicators (UPMI). It details the results of analysis of FY 2007-2008 pharmacy claims data using these indicators that enabled the Program to identify practices and prescribers that required targeted interventions. The most frequently triggered UPMI for adults involved the use of 2 or more antipsychotics for greater than 60 days; high doses of psychotherapeutic medications was the indicator most frequently triggered for children closely followed by the use of 2 or more antipsychotics for more than 45 days. Prescriptions that triggered UPMI were concentrated in a small number of prescribers. These results led to the Program focusing on these high frequency practices and on the prescribers most associated with them. They also led to the implementation of new quality improvement initiatives like the implementation of a psychiatric telephone consultation line for pediatricians who are treating children with serious emotional disturbances who do not have access to child psychiatrists.
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Affiliation(s)
- Robert J Constantine
- Florida Mental Health Institute, University of South Florida, Tampa, FL 33612, USA.
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French SD, Green S, Buchbinder R, Barnes H. Interventions for improving the appropriate use of imaging in people with musculoskeletal conditions. Cochrane Database Syst Rev 2010; 2010:CD006094. [PMID: 20091583 PMCID: PMC7390432 DOI: 10.1002/14651858.cd006094.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Imaging is commonly performed for musculoskeletal conditions. Identifying interventions to improve the appropriate use of imaging for musculoskeletal conditions could potentially result in improved health outcomes for patients and reduced health care costs. OBJECTIVES To determine the effects of interventions that aim to improve the appropriate use of imaging for people with musculoskeletal conditions. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (June 2007), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (January 1966 to June 2007), EMBASE (January 1980 to June 2007) and CINAHL (January 1982 to June 2007). We also searched reference lists of included studies and relevant reviews. We undertook citation searches of all included studies, contacted authors of included studies, and contacted other experts in the field of effective professional practice. SELECTION CRITERIA Randomised controlled trials, non-randomised controlled clinical trials and interrupted time-series analyses that evaluated interventions designed to improve the use of imaging for musculoskeletal symptoms. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. MAIN RESULTS Twenty eight studies met our inclusion criteria. The majority of the studies were for the management of osteoporosis or low back pain, and most evaluated interventions aimed at health professionals. To improve the use of imaging in the management of osteoporosis, the effect of any type of intervention compared to no-intervention controls was modest (absolute improvement in bone mineral density test ordering +10%, IQR 0.0 to +27.7). Patient mediated, reminder, and organisational interventions appeared to have most potential for improving imaging use in osteoporosis. For low back pain studies, the most common intervention evaluated was distribution of educational materials and this showed varying effects. Other interventions in low back pain studies also showed variable effects. For other musculoskeletal conditions, distribution of educational materials, educational meetings and audit and feedback were not shown to be effective for changing imaging ordering behaviour. Across all conditions, increasing the number of intervention components did not increase effect. AUTHORS' CONCLUSIONS For improving the use of imaging in osteoporosis, most professional interventions demonstrated benefit, and patient mediated, reminder, and organisational interventions appeared to have most potential for benefit. For low back pain studies interventions showed varying effects. For other musculoskeletal conditions, no firm conclusions can be drawn.
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Affiliation(s)
- Simon D French
- Monash UniversityMonash Institute of Health Services Research43 ‐ 51 Kanooka GroveMonash Medical Centre, Locked Bag 29ClaytonVICAustralia3168
| | - Sally Green
- Monash UniversityMonash Institute of Health Services Research43 ‐ 51 Kanooka GroveMonash Medical Centre, Locked Bag 29ClaytonVICAustralia3168
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology at Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Hayley Barnes
- Monash Institute of Health Services Researchc/o Australasian Cochrane CentreLocked Bag 29Monash Medical CentreClaytonVictoriaAustralia3168
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Davis D, Galbraith R. Continuing medical education effect on practice performance: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 2009; 135:42S-48S. [PMID: 19265075 DOI: 10.1378/chest.08-2517] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There has been sizable debate and widespread skepticism about the effect of continuing medical education (CME) on the performance of physicians in the practice setting. This portion of the review was undertaken to examine that effect. METHODS The guideline panel used data from a comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center, focusing on the effect of CME on clinical performance. RESULTS The review found 105 studies, which evaluated the impact of CME on short- and long-term physician practice performance. Nearly 60% met objectives relative to changing clinical performance in prescribing; screening; counseling about smoking cessation, diet, and sexual practices; guideline adherence; and other topics. Single live and multiple media appeared to be generally positive in their effect, print media much less so. Multiple educational techniques were more successful at changing provider performance than single techniques. The amount or frequency of exposure to CME activities appeared to have little effect on behavior change. CONCLUSIONS Overall, CME, especially using live or multiple media and multiple educational techniques, is generally effective in changing physician performance. More research, however, is needed that focuses on the specific types of media and educational techniques that lead to the greatest improvements in performance.
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Affiliation(s)
- Dave Davis
- Association of American Medical Colleges, Washington, DC 20037, USA.
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Kasturi GC, Cifu DX, Adler RA. A Review of Osteoporosis: Part I. Impact, Pathophysiology, Diagnosis and Unique Role of the Physiatrist. PM R 2009; 1:254-60. [DOI: 10.1016/j.pmrj.2008.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/10/2008] [Accepted: 12/09/2008] [Indexed: 10/21/2022]
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Palonen KP, Saag KG. Improving the quality of clinical care for patients with osteoporosis. Expert Rev Pharmacoecon Outcomes Res 2006; 6:641-5. [PMID: 20528489 DOI: 10.1586/14737167.6.6.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteoporosis, leading to hip fractures and other fragility fractures, is prevalent in countries with a high life expectancy. Fractures have a high associated societal cost and disease burden. As a result, many countries have established screening guidelines for osteoporosis, especially targeting those at a higher risk. However, primary- and secondary-fracture prevention is currently suboptimal despite existence of effective medications. In addition, adherence to therapy is low. This special report outlines some of these challenges and evaluates different techniques for improving the quality of clinical care for patients with osteoporosis.
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Affiliation(s)
- Katri P Palonen
- Summit Medical Center, Summit Medical Associates, PC, Hermitage, TN, USA.
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Thomas DC, Johnston B, Dunn K, Sullivan GM, Brett B, Matzko M, Levine SA. Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians. J Am Geriatr Soc 2006; 54:1610-8. [PMID: 17038082 DOI: 10.1111/j.1532-5415.2006.00879.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.
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Affiliation(s)
- David C Thomas
- Department of Medicine and Rehabilitation Medicine, Outpatient Services, Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
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McNearney TA, Shepherd AJ, Chhabra A, Goel N. Primary care house staff attitudes toward osteoporosis management. South Med J 2006; 99:461-6. [PMID: 16711307 DOI: 10.1097/01.smj.0000216495.79818.eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study assessed possible institutional and patient-related factors influencing the delivery of postmenopausal osteoporosis (PMO) care and the diagnostic priority placed on addressing PMO, relative to other common medical conditions, by primary care house staff at our institution. METHODS A questionnaire was designed and distributed to eligible house staff at our institution. RESULTS Approximately 50% (n = 52) of the house staff participated. The supervising clinic attending, patients' lack of insurance, accessibility to medical care, comorbid conditions, and university formulary were reported to influence decisions regarding osteoporosis care. Osteoporosis was ranked 6th of 7 medical issues (hypertension, coronary artery disease, diabetes, hypercholesterolemia, adult immunizations, osteoporosis, thyroid disease) to address during a comprehensive medical visit. CONCLUSIONS Our institution's primary care house staff reported multiple influences on decision making regarding osteoporosis care, and an overall low priority to address this issue. Based on PMO's associated morbidity and mortality, primary care training programs are challenged to put resources toward optimizing house staff delivery of osteoporosis care.
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Affiliation(s)
- Terry A McNearney
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Johnson SL, Petkov VI, Williams MI, Via PS, Adler RA. Improving osteoporosis management in patients with fractures. Osteoporos Int 2005; 16:1079-85. [PMID: 15586267 DOI: 10.1007/s00198-004-1814-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 09/23/2004] [Indexed: 10/26/2022]
Abstract
A history of fracture is an independent risk factor for future fractures, but patients who have sustained a fracture are rarely evaluated for osteoporosis (OP). The objective of this study was to determine if a simple intervention in a general orthopedic clinic would lead to more fracture patients receiving evaluation and treatment for OP. Patients with a history of fracture visiting a weekly orthopedic clinic during a 6-month intervention period were educated about OP, and a bone mineral density (BMD) test was offered. The number of BMD tests performed and other OP-specific actions taken as a result of the intervention were compared with a 6-month pre-intervention period. The prevalence of OP in those who underwent BMD testing was examined. In the pre-intervention period, only 12.7% (16 of 126) had a BMD test as compared with 62.5% of the 136 intervention-period subjects (odds ratio [OR] 11.5, 95% confidence interval [CI] 6.1, 21.4). Based on BMD test results, 11.9% of the pre-intervention patients, and 41.9% of the intervention patients received OP-specific recommendations (OR 5.3, 95% CI 2.8, 10.1). The intervention led to more patients being treated for low bone mass (9.5% vs 23.5%); OR 2.9, 95% CI 1.4, 5.9. Low bone mass was common among all types of fracture patients: 20% had osteoporosis and 41%, osteopenia. BMD testing in patients with fractures should identify those at risk for future fractures, leading to appropriate treatment.
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Affiliation(s)
- S L Johnson
- Endocrinology Section, McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA
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Ghosh AK, Ghosh K. Translating evidence-based information into effective risk communication: Current challenges and opportunities. ACTA ACUST UNITED AC 2005; 145:171-80. [PMID: 15962835 DOI: 10.1016/j.lab.2005.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent medical advances and the easy availability of evidence-based information at the point of care are believed to provide physicians with improved tools for risk communication. However, evidence indicates that physicians still display marked variability in ordering tests. Factors that determine a physician's test-ordering tendencies vary by specialization, practice, geographical location, defensive practice, and tolerance of uncertainty and are also modified by patient requests. Understanding of statistical terms on the part of both physicians and patients remains limited. Physicians may display limited ability to assess pretest and posttest probabilities, especially in low- and intermediate-risk patients, even after attending short courses in epidemiology, or may find the process impractical. Presentation of diagnostic-test results in a natural-frequency format might improve understanding. Both physicians and patients have difficulty grasping the term "number needed to treat" compared with "relative risk reduction" when comparing therapeutic options. Other patient-related factors that limit understanding include low literacy, individual risk tolerance, and framing patterns of the problem (potential gains vs losses). Despite numerous available modalities (quantitative and qualitative) of risk communication, consensus over the advantage of any single modality in translating evidence into risk communication is limited. It is essential that physicians remain patient-centered, generate trust, and build a partnership with the patient to achieve consensus for medical decision-making. Future studies are indicated to assess the effectiveness of novel risk-communication modalities based on patients' and physicians' characteristics and identify appropriate modality of translating evidence (quantitative or qualitative information).
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Affiliation(s)
- Amit Kumar Ghosh
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 2005; 16:115-27. [PMID: 15517187 DOI: 10.1007/s00198-004-1750-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2004] [Accepted: 08/20/2004] [Indexed: 10/26/2022]
Abstract
During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, 31905, Haifa, Israel.
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Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, Solomon DH. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med 2004; 19:783-90. [PMID: 15209594 PMCID: PMC1492483 DOI: 10.1111/j.1525-1497.2004.30240.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD testing patterns, and interventions to increase BMD testing. DESIGN We searched medline and HealthSTAR from 1992 through 2002 using appropriate search terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form. MEASUREMENTS AND MAIN RESULTS A total of 235 articles were identified, and 51 met criteria for review: 24 practice guidelines, 22 studies of screening patterns, and 5 interventions designed to increase BMD rates. Of the practice guidelines, almost one half (47%) lacked a formal description of how they were developed, and recommendations for populations to screen varied widely. Screening frequencies among at-risk patients were low, ranging from 1% to 47%. Only eight studies assessed factors associated with BMD testing. Female patient gender, glucocorticoid dose, and rheumatologist care were positively associated with BMD testing; female physicians, rheumatologists, and physicians caring for more postmenopausal patients were more likely to test patients. Five articles described interventions to increase BMD testing rates, but only two tested for statistical significance and no firm conclusions can be drawn. CONCLUSIONS This systematic review identified several possible contributors to suboptimal BMD testing rates. Osteoporosis screening guidelines lack uniformity in their development and content. While some patient and physician characteristics were found to be associated with BMD testing, few articles carefully assessed correlates of testing. Almost no interventions to improve BMD testing to screen for osteoporosis have been rigorously evaluated.
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Affiliation(s)
- Charles A Morris
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Meadows LM, Mrkonjic LA, Lagendyk LE, Petersen KMA. After the Fall: Women's Views of Fractures in Relation to Bone Health at Midlife. Women Health 2004; 39:47-62. [PMID: 15130861 DOI: 10.1300/j013v39n02_04] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.
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Affiliation(s)
- Lynn M Meadows
- Departments of Family Medicine & Community Health Sciences, University of Calgary, Canada.
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Morris CA, Cheng H, Cabral D, Solomon DH. Predictors of Screening and Treatment of Osteoporosis. ACTA ACUST UNITED AC 2004. [DOI: 10.1097/01.ten.0000123564.40707.84] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hip fractures are associated with 10% to 20% excess mortality in the first year and cause functional disability in most survivors. An estimated 17% of white women in the United States will sustain a hip fracture after the age of 50 years. Despite the availability of evidence-based guidelines for hip fracture prevention, routine screening and preventive measures have not been incorporated into standard primary care practice. Many physicians lack adequate knowledge to initiate bone mineral density testing and treatment with preventive medications to decrease the incidence of osteoporosis and fractures. Furthermore, patients are less likely to request information about bone health than about diseases for which systematic screening and prevention protocols have been established. This review describes preventive measures to decrease hip fracture in postmenopausal women, including screening by bone mineral density testing, risk factor assessment, and chemoprevention. Existing guidelines are summarized, and dilemmas regarding their implementation are discussed.
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Affiliation(s)
- Margaret Gourlay
- Robert Wood Johnson Clinical Scholars Program, Department of Family Medicine, University of North Carolina, Chapel Hill 27599-7105, USA.
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Piniewski-Bond J, Celestino PB, Mahoney MC, Farrell CD, Bauer JE, Hastrup JL, Cummings KM. A cancer genetics education campaign: delivering parallel messages to clinicians and the public. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2003; 18:96-99. [PMID: 12888384 DOI: 10.1207/s15430154jce1802_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Up to 10% of all cancers are thought to have a familial basis through complex interactions between genes and environment. METHODS A community-wide education campaign was conducted that included several elements: a five part television news series; an educational newsletter; web site pages and links to educational materials; a Continuing Medical Education (CME) program for professionals; and an evaluation survey. RESULTS Survey estimates revealed that 39000 households recalled seeing the series; 14800 households changed their views about the risks of hereditary cancers; and about 9900 households were made more aware/informed about cancer and hereditary risk. CONCLUSION This awareness campaign broadened public knowledge about the myths and realities associated with genetic factors and cancer risk. It reinforced the importance of early screening for persons at high risk of cancer due to hereditary factors.
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