Use of a decision aid to improve treatment decisions in osteoporosis: The osteoporosis choice randomized trial

Victor Manuel Montori, Nilay D Shah, Laurie J. Pencille, Megan E. Branda, Holly K. Van Houten, Brian A. Swiglo, Rebecca L. Kesman, Sidna M. Tulledge-Scheitel, Thomas M. Jaeger, Ruth E. Johnson, Gregory A. Bartel, L. Joseph Melton, Robert A. Wermers

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed. Methods: Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles. Results: A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n = 52) or usual care (n = 48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n = 23 [100%] vs n = 14 [74%]; P = .009). Conclusion: A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.

Original languageEnglish (US)
Pages (from-to)549-556
Number of pages8
JournalAmerican Journal of Medicine
Volume124
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Decision Support Techniques
Diphosphonates
Osteoporosis
Patient Participation
Confidence Intervals
Therapeutics
Primary Health Care
Numbers Needed To Treat
Video Recording
Pamphlets
Cost Control
Patient Preference
Risk Reduction Behavior
Health Expenditures
Bone Density
Medical Records
Prescriptions
Decision Making

Keywords

  • Bisphosphonates
  • Clinical trial
  • Decision aid
  • Osteoporosis
  • Primary care
  • Shared decision-making

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Use of a decision aid to improve treatment decisions in osteoporosis : The osteoporosis choice randomized trial. / Montori, Victor Manuel; Shah, Nilay D; Pencille, Laurie J.; Branda, Megan E.; Van Houten, Holly K.; Swiglo, Brian A.; Kesman, Rebecca L.; Tulledge-Scheitel, Sidna M.; Jaeger, Thomas M.; Johnson, Ruth E.; Bartel, Gregory A.; Melton, L. Joseph; Wermers, Robert A.

In: American Journal of Medicine, Vol. 124, No. 6, 06.2011, p. 549-556.

Research output: Contribution to journalArticle

Montori, VM, Shah, ND, Pencille, LJ, Branda, ME, Van Houten, HK, Swiglo, BA, Kesman, RL, Tulledge-Scheitel, SM, Jaeger, TM, Johnson, RE, Bartel, GA, Melton, LJ & Wermers, RA 2011, 'Use of a decision aid to improve treatment decisions in osteoporosis: The osteoporosis choice randomized trial', American Journal of Medicine, vol. 124, no. 6, pp. 549-556. https://doi.org/10.1016/j.amjmed.2011.01.013
Montori, Victor Manuel ; Shah, Nilay D ; Pencille, Laurie J. ; Branda, Megan E. ; Van Houten, Holly K. ; Swiglo, Brian A. ; Kesman, Rebecca L. ; Tulledge-Scheitel, Sidna M. ; Jaeger, Thomas M. ; Johnson, Ruth E. ; Bartel, Gregory A. ; Melton, L. Joseph ; Wermers, Robert A. / Use of a decision aid to improve treatment decisions in osteoporosis : The osteoporosis choice randomized trial. In: American Journal of Medicine. 2011 ; Vol. 124, No. 6. pp. 549-556.
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AU - Van Houten, Holly K.

AU - Swiglo, Brian A.

AU - Kesman, Rebecca L.

AU - Tulledge-Scheitel, Sidna M.

AU - Jaeger, Thomas M.

AU - Johnson, Ruth E.

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N2 - Objective: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed. Methods: Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles. Results: A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n = 52) or usual care (n = 48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n = 23 [100%] vs n = 14 [74%]; P = .009). Conclusion: A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.

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