Optimizing care in osteoporosis: The Canadian quality circle project

George Ioannidis,Amiram Gafni,Anthony Hodsman,Nathalie Plumley,Lehana Thabane,Alexandra Papaioannou,Famida Jiwa,Jonathan D Adachi,Brent Kvern,Lena Salach,Dan Johnstone

doi:10.1186/1471-2474-9-130

Abstract

BackgroundWhile the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines.MethodsThe project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.ResultsAfter the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7).ConclusionQuality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.

Highlights

While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches
Awareness of risk factors The percentage of primary care physicians who were uncertain of their patients' risk factor status was generally low
Results generated from the generalized estimating equations method showed that physicians' certainty of risk factor awareness significantly increased during the first year of the study

Summary

Introduction

While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines. While the Osteoporosis Canada 2002 Canadian guidelines [9] provided evidence based strategies in managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians' clinical approaches [13]. We hypothesize that primary care physicians' perceived awareness of osteoporosis risk factors in their patients and bone mineral density testing would change in accordance with the Osteoporosis Canada guidelines as a result of their enrollment in the study

Methods

Results

Discussion

Conclusion