Yood Robert A, Mazor Kathleen M, Andrade Susan E, Emani Srinivas, Chan Wing, Kahler Kristijan H
Fallon Clinic, Worcester, MA 01605, USA.
J Gen Intern Med. 2008 Nov;23(11):1815-21. doi: 10.1007/s11606-008-0772-0. Epub 2008 Sep 12.
There are effective treatments to prevent osteoporotic fractures, but these treatments are underutilized.
To evaluate the influence of patient characteristics, perceptions, knowledge and beliefs about osteoporosis on the decision to initiate osteoporotic treatment.
We identified female members of a managed care plan who had a dual energy x-ray absorptiometry (DXA) bone density test and fulfilled World Health Organization criteria for osteoporosis. Patients were excluded if they received osteoporotic medications in the prior 6 months.
Patients were sent a questionnaire that included items assessing satisfaction with physician-patient communication, trust in the physician, osteoporosis knowledge and beliefs, beliefs about prescription medications, and perceptions of barriers to medication use. Administrative electronic health records were used to identify prescription drug use and health care utilization.
Two hundred and thirty-six women returned surveys and research authorization forms out of 465 contacted for participation. One hundred and thirty-five (57.2%) filled a prescription for an osteoporotic drug in the first 3 months after the DXA exam. The largest differences between initiators and non-initiators were in beliefs in the benefits of medications, and distrust of medications, with initiators believing more strongly in the benefits and effectiveness of medications (p < .001), and non-initiators reporting more distrust of medications (p < .001). Osteoporosis knowledge and the belief that osteoporosis is a serious disease were also related to therapy initiation in bivariate analysis.
Only 57% of patients initiated osteoporotic medication within 3 months of diagnosis. The decision to start osteoporosis treatment appeared to be related to a patient's beliefs in the effectiveness of osteoporosis medications and distrust of medications.
有有效的治疗方法可预防骨质疏松性骨折，但这些治疗方法未得到充分利用。
评估患者特征、对骨质疏松症的认知、知识和信念对启动骨质疏松症治疗决策的影响。
我们确定了参加管理式医疗计划的女性成员，她们进行了双能X线吸收法（DXA）骨密度检测，并符合世界卫生组织的骨质疏松症标准。如果患者在过去6个月内服用过骨质疏松症药物，则将其排除。
向患者发送一份问卷，其中包括评估医患沟通满意度、对医生的信任、骨质疏松症知识和信念、对处方药的信念以及对药物使用障碍的认知等项目。使用行政电子健康记录来确定处方药使用情况和医疗保健利用率。
在465名被联系参与的女性中，有236名女性返回了调查问卷和研究授权表。135名（57.2%）女性在DXA检查后的前3个月内开具了骨质疏松症药物处方。启动治疗者和未启动治疗者之间最大的差异在于对药物益处的信念和对药物的不信任，启动治疗者更坚信药物的益处和有效性（p <.001），而未启动治疗者对药物的不信任程度更高（p <.001）。在双变量分析中，骨质疏松症知识以及认为骨质疏松症是一种严重疾病的信念也与开始治疗有关。
只有57%的患者在诊断后3个月内开始使用骨质疏松症药物。开始骨质疏松症治疗的决策似乎与患者对骨质疏松症药物有效性的信念和对药物的不信任有关。
