A Patient Activation Intervention to Enhance Bone Health

描述（由申请人提供）：骨密度（BMD）在成年早期达到峰值，并随着年龄的增长逐渐下降。随着骨密度从正常下降到低（以前称为骨质减少），再到骨质疏松，骨折的风险逐渐增加。为了防止骨质流失和降低骨折风险，包括美国预防服务工作组和外科医生办公室在内的大多数广泛接受的指导方针现在推荐使用双能x射线吸收仪（DXA）对老年人进行骨密度筛查。筛查的基本原理是患者及其提供者将DXA结果作为“采取行动的线索”，并采取必要措施通过改变生活方式（如负重运动）、补充钙/维生素D和必要时的药物治疗来增强骨骼健康。然而，多项研究表明，在DXA检测后，患者和提供者往往不能采取建议的行动，从而违背了筛查的大部分目的。在过去的五年中，我们系统地开发和试点测试了基于健康信念模型的低成本和实用的患者激活干预。干预包括DXA扫描中心向每位患者邮寄一封定制的信件，其中包含他们的DXA扫描结果和骨质疏松症的教育信息，并辅以护士教育工作者的后续电话。初步研究表明，该干预措施得到了患者和提供者的好评，并提高了与骨相关的护理质量。当前提案的总体目标是通过在三个研究地点进行的随机对照试验，严格检查患者激活干预对接受筛查DXA扫描的成人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实际成本，以及我们的干预对BMD筛查的总体成本效益的影响。我们假设激活干预将增加钙/维生素D摄入的优化，增加药物治疗的使用，将提高患者对骨骼相关保健的满意度，并提高患者对骨质疏松症的专业知识，与常规护理相比。

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.