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Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusion

A tailored DXA result letter and educational brochure failed to improve guideline-concordant care in patients who received DXA.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, Canada

    P. Cram

  2. Division of General Internal Medicine, Mt. Sinai/UHN Hospitals, Toronto, Canada

    P. Cram

  3. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    P. Cram, F. D. Wolinsky, S. W. Edmonds & S. F. Hall

  4. Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA

    F. D. Wolinsky

  5. University of Iowa College of Nursing, Iowa City, IA, USA

    F. D. Wolinsky & S. W. Edmonds

  6. The University of Iowa, 145 North Riverside Drive, CPHB N211, Iowa City, IA, 52242, USA

    F. D. Wolinsky

  7. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA

    Y. Lou & M. P. Jones

  8. Kaiser Permanente, Atlanta, GA, 30305, USA

    D. W. Roblin

  9. School of Public Health, Georgia State University, Atlanta, GA, USA

    D. W. Roblin

  10. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    N. C. Wright

  11. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA

    N. C. Wright & K. G. Saag

Authors
  1. P. Cram
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  9. K. G. Saag
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Consortia

on behalf of the PAADRN Investigators

Corresponding author

Correspondence to F. D. Wolinsky.

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Funding/support

This work was supported by R01 AG033035 (Cram/Wolinsky) from the NIA at NIH. Dr. Cram is supported by a K24 AR062133 award from NIAMS at the NIH. Dr. Saag is supported by a K24 AR052361 award from the NIAMS at the NIH.

Role of the sponsor

The NIA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Conflicts of interest

P. Cram, M. P. Jones, F. D. Wolinsky, S. W. Edmonds, S. F. Hall, Y. Lou, and D. W. Roblin have no conflicts of interest. N. C. Wright has received unrestricted grant support from Amgen for work unrelated to this project. K. G. Saag has received grants from Amgen, Eli Lilly, and Merck and has served as a paid consultant to Amgen, Eli Lilly, and Merck unrelated to this project.

Additional information

Jeffrey R. Curtis, MD, MPH; Sarah L. Morgan, RD, MD, CCD, FACP; Janet A. Schlechte, MD; Jessica H. Williams, MPH, PhD; David J. Zelman, MD

Trial Registration: clinicaltrials.gov identifier NCT01507662

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Cram, P., Wolinsky, F.D., Lou, Y. et al. Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial. Osteoporos Int 27, 3513–3524 (2016). https://doi.org/10.1007/s00198-016-3681-9

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  • DOI: https://doi.org/10.1007/s00198-016-3681-9

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