McMaster University, Hamilton, Ontario, Canada.
GERAS Centre for Aging Research, St. Peter's Hospital, Hamilton Health Sciences, 88 Maplewood Ave, Hamilton, Ontario, L8M 1W9, Canada.
Arch Osteoporos. 2021 Apr 24;16(1):76. doi: 10.1007/s11657-021-00919-4.
Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified.
To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk.
The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool.
Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG.
Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.
确定骨质疏松症管理方面的护理差距，重点是关注与加拿大临床实践指南（CPG）相关的骨密度（BMD）检测、10 年骨折风险计算以及高危人群的治疗。
ADVANTAGE OP EMR 工具包括一个交互式算法，用于使用 CPG 评估和管理骨折风险。FRAX®和加拿大放射科医师协会和骨质疏松症加拿大协会（CAROC）工具被嵌入其中，以促进 10 年骨折风险计算。医生根据临床指征管理患者，但使用 EMR 提醒指南建议；参与者在使用该工具 18 个月后分享管理活动的实践水平数据。
在同意参与这项研究的 154 名医生中，有 84 名（54%）分享了他们的总体实践活动。在所有实践中，有 171310 名年龄在 40 岁及以上的成年患者，其中 17214 名（10%）处于骨折高发风险。62%的潜在骨折高发风险患者未完成 BMD 检测；最常见的原因是打算以后再开 BMD 检测（48%）、医生认为不需要 BMD（15%）和患者拒绝（20%）。对于完成 BMD 检测的患者，有 29%计算了骨折风险；19%处于高风险，其中 37%未按 CPG 建议用骨质疏松症药物治疗。
尽管通过 ADVANTAGE OP EMR 工具可以获得 CPG 和骨折风险计算器，但在骨折风险计算和骨质疏松症管理方面仍存在显著差距。需要采取额外的策略来解决家庭医生的这种临床惰性。
