Miller Karla L, Mccoy Kimberly, Richards Chris, Seaman Aaron, Solimeo Samantha L
VHA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City, Department of Internal Medicine, Rheumatology Section Veterans Affairs Salt Lake City Health Care System Salt Lake City Utah USA.
Associate Professor (Clinical) of Medicine, Division of Rheumatology University of Utah School of Medicine Salt Lake City Utah USA.
JBMR Plus. 2022 Oct 3;6(10):e10682. doi: 10.1002/jbm4.10682. eCollection 2022 Oct.
A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design ( = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy ( = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, self-reported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems. Published 2022. This article is a U.S. Government work and is in the public domain in the USA. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
在美国西部山区，实施了一项使用虚拟骨健康团队（BHT）的原发性骨质疏松症预防计划，以共同管理农村退伍军人的护理。BHT通过电话和美国邮政服务通信，识别、筛查和治疗有骨质疏松症风险的农村退伍军人。资格由退伍军人健康管理局初级保健的定期使用、年龄50岁或以上以及骨折风险证据来确定。本研究旨在确定与接受骨质疏松症筛查以及在有指征时开始用药相关的人口统计学和临床因素。采用横断面队列设计（n = 6985），并使用广义估计方程和logit链接函数来考虑机构层面的聚类。使用向后选择拟合完全饱和模型和简化模型。不到四分之一的符合条件的退伍军人参加了BHT计划并完成了筛查。与较低的诊所登记可能性相关的因素包括年龄较大、未婚、距离退伍军人健康管理局服务机构较远、有自付费用、既往骨折或类风湿关节炎病史。大多数有治疗指征的退伍军人开始了药物治疗（n = 453）。在这个亚人群中，Fisher精确检验显示，骨质疏松症治疗的接受与前一年两次或更多次跌倒的病史、自我报告的父母骨折病史、当前吸烟以及负重运动之间存在显著关联。BHT旨在减少筛查障碍；然而，对于这个人群来说，成本和出行仍然限制了参与度。尽管药物启动率很高，但低登记率降低了这项一级预防计划的影响，与骨折、吸烟和运动相关的研究结果表明，健康观念是一个重要的促成因素。识别和解决骨质疏松症筛查和治疗障碍的努力，如临床因素、健康的社会决定因素和健康观念，可能为有效实施人群骨保健提供系统铺平道路。2022年发表。本文是美国政府作品，在美国属于公共领域。由Wiley Periodicals LLC代表美国骨与矿物质研究学会发表。
