Effect of self-referral on bone mineral density testing and osteoporosis treatment

Med Care. 2014 Aug;52(8):743-50. doi: 10.1097/MLR.0000000000000170.

Abstract

Background: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening.

Objective: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral).

Research design: Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG).

Subjects: Women aged 65 years and older without a DXA in past 5 years.

Measures: DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing.

Results: From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0%-24.1% self-referral vs. 4.9%-5.9% UC, P<0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared with UC (P<0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8%-3.4%) but significantly greater among self-referral versus UC in KPNW.

Conclusions: DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Absorptiometry, Photon
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Bone Density*
  • Comorbidity
  • Diagnostic Self Evaluation*
  • Female
  • Humans
  • Mass Screening / statistics & numerical data*
  • Osteoporosis / diagnosis*
  • Patient Education as Topic / statistics & numerical data*
  • Racial Groups