NASHVILLE, Tenn. – Even with the availability of training programs and educational literature, it is rare for many orthopaedic surgeons and neurologists, physicians who regularly see patients at high risk for fractures, to refer these patients for assessment of bone mineral density (BMD), according to a study presented here at the 27th Annual Meeting of the American Society for Bone and Mineral Research.
In a study of 60 orthopaedic surgeons and neurologists, it was found that only 2 patients were referred for evaluation by dual x-ray absorptiometry (DEXA) over a 6-month period. The physicians had attended meetings and received literature designed to inform them about the need for BMD assessment of patients with a history of fragility fractures or hemiplegic stroke.
"What we've learned from this is that changing physician behavior takes time; [it] takes more than just education, it takes greater awareness," said David R. Mandel, MD, lead author of the study and a rheumatologist in private practice in Mayfield Village, Ohio. "We are still looking into solutions to help physicians who come across patients every day in their practice who are at significant risk for fracture, so these patients can be identified in a more timely way."
The study involved 40 orthopaedic specialists and 20 neurologists, who received invitations to refer patients with fragility fractures or hemiplegic stroke within the past year for DEXA assessments. Each physician was provided with 6 vouchers that would enable their patients to receive a free DEXA BMD study. In addition to the informational meetings and literature, the referring physicians would receive $150 gift certificates if they referred 6 patients.
In the first 3 months after the initial invitation, a total of 2 patients were referred for DEXA studies, both by orthopaedic surgeons. Additional educational seminars were conducted, and follow-up letters and information were sent to the physicians who were originally contacted, the study authors note. No additional patients were referred for the free DEXA studies in the 3 months following the second contact with the orthopaedic surgeons and neurologists.
According to Dr. Mandel, patients with stroke have a fourfold increased risk of fracture, and patients with a history of fragility fracture are at significantly increased risk for future fractures. Studies have shown that medical care often might be delayed for such high-risk patients due to a lack of timely BMD assessment.
"There is an urgent need [for] continued education and awareness, particularly [for] physicians who evaluate patients who are at higher risk for fracture," Dr. Mandel says.
Reference
1. Mandel DR, Scott PL. Failure to motivate orthopaedic surgeons and neurologists to refer high-risk patients for DEXA. Presented at: 27th Annual Meeting of the American Society for Bone and Mineral Research; September 23-27, 2005; Nashville, Tennessee. Abstract SA 294.