Clinical studiesAdherence with osteoporosis practice guidelines: A multilevel analysis of patient, physician, and practice setting characteristics
Section snippets
Study samples
This study included all 10 primary care practices affiliated with one large academic medical center; half are hospital based and the others are community based. Each practice is linked through a centralized electronic medical record, and each physician is affiliated with one of the 10 practices. All physicians are trained in internal medicine; some have additional subspecialty training but practice as primary care physicians. Residents in internal medicine at several different sites were
Results
A total of 6311 patients met one of the four inclusion criteria; some met more than one criterion (Table 1). The mean (± SD) age of patients was 69 ± 13 years. Most patients were female and there was a wide racial distribution. The average number of comorbid conditions was one, and 60% of patients were taking at least one medicine. There were some differences among the patients meeting different at-risk criterion; subjects in the oral glucocorticoid user group were the youngest and those in the
Discussion
We examined the associations between patient, physician, and practice site characteristics and adherence to local osteoporosis guidelines in a large group of patients at risk of osteoporosis who were seen by primary care doctors affiliated with one academic medical center. Several patient characteristics were associated with undergoing bone mineral density testing or receiving a medication for osteoporosis (or both), and included age, sex, race, and comorbid conditions. Physician sex was also a
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Supported in part by grant HS11046 from the Agency for Healthcare Research and Quality. Dr. Solomon is also supported by grants AR48616 and AR48264 from the National Institutes of Health, and by the Arthritis Foundation.