A Patient Activation Intervention to Enhance Bone Health

描述(申请人提供)：骨密度(BMD)在成年早期达到峰值，并随着年龄的增长而逐渐下降。随着骨密度从正常下降到低(以前称为骨量减少)，再到骨质疏松，骨折的风险逐渐增加。为了防止骨丢失和降低骨折风险，包括美国预防服务工作组和卫生局局长办公室在内的大多数被广泛接受的指南现在建议使用双能X射线吸收法(DXA)对老年人进行骨密度筛查。筛查的基本原理是，患者和他们的提供者将把DXA结果作为“行动的提示”，并采取必要的步骤，通过改变生活方式(例如，负重锻炼)、补充钙/维生素D以及在有需要的情况下进行药物治疗来增强骨骼健康。然而，多项研究表明，患者和提供者在DXA测试后经常无法采取建议的措施，从而违背了筛查的大部分目的。在过去的五年里，我们基于健康信念模型，系统地开发和试点测试了一种低成本和实用的患者激活干预措施。干预包括DXA扫描中心向每个患者邮寄一封定制的信件，其中包含他们的DXA扫描结果以及有关骨质疏松症的教育信息，并辅之以护士教育人员的后续电话。初步研究表明，这种干预措施得到了患者和提供者的好评，并提高了与骨骼相关的护理质量。当前建议的首要目标是通过在三个研究地点进行的随机对照试验，严格检查我们的患者激活干预对接受DXA扫描筛查的成年人的骨相关护理质量的影响。此外，我们将研究与我们的干预相关的真实成本，以及我们的干预对骨密度筛查的整体成本效益的影响。我们假设，与常规护理相比，激活干预将增加钙/维生素D摄入量的最优化，在有适应症的情况下加强药物治疗的使用，将提高患者对骨相关保健的满意度，并提高患者对骨质疏松症的专门知识。

DESCRIPTION (provided by applicant): Bone mineral density (BMD) peaks in early adulthood and declines progressively with aging. As BMD declines from normal, to low (formerly called osteopenia), to osteoporosis, risk of fractures progressively increases. In an effort to prevent bone loss and reduce fracture risk, most widely accepted guidelines including the U.S. Preventive Services Task Force and Surgeon General's Office now recommend BMD screening of older adults using dual energy x-ray absorptiometry (DXA). The rationale for screening is that patients and their providers will use DXA results as a "cue to action" and take necessary steps to enhance bone health through lifestyle modification (e.g., weight bearing exercise), Calcium/Vitamin D supplementation, and pharmacotherapy when indicated. However, multiple studies have demonstrated that patients and providers often fail take recommended actions following DXA testing, thus defeating much of the purpose of screening. Over the past five years we have systematically developed and pilot tested a low-cost and practical patient activation intervention based upon the Health Belief Model. The intervention consists of the DXA scanning center mailing each patient a customized letter containing the results of their DXA scan plus educational information about osteoporosis, supplemented by a follow-up phone call from a nurse educator. Preliminary studies have demonstrated that the intervention is well received by both patients and providers and enhances bone-related quality of care. The overarching objective of the current proposal is to rigorously examine the impact of our patient activation intervention on bone-related quality of care in adults undergoing screening DXA scans through a randomized-controlled trial conducted at three study sites. In addition, we will examine the real-world costs associated with our intervention and the impact of our intervention on the overall cost-effectiveness of BMD screening. We hypothesize that the activation intervention will increase optimization of Calcium/Vitamin D intake, enhance use of pharmacotherapy when indicated, will improve patient satisfaction with their bone-related healthcare, and improve patients' osteoporosis specific knowledge when compared with usual care.