INTRODUCTION: Osteoporosis is a skeletal disorder of aging, caused by loss of bone mass and deterioration in both bone quality and micro-architecture. The U.S. Preventive Services Task Force (USPSTF) recommends women ages 65 and older without previous known fractures or secondary causes of osteoporosis be screened using Dual-Energy X-ray Absorptiometry (DEXA). METHODS: This retrospective chart review assessed compliance with osteoporosis screening guidelines in a resident clinic. We reviewed all charts of female patients 65 years or older at the Women’s Health Firm of Queen Emma Clinic in Honolulu, Hawaii from July 1, 2014 through July 1, 2015. Age, ethnicity, insurance type, presence of DEXA results and ordering provider type were abstracted. Associations between patient characteristics and DEXA screening were evaluated. RESULTS: 96 charts were reviewed with 87 meeting inclusion criteria, with mean age 69.6 (SD + 4.6) years. Of those, 92% (80/87) were offered DEXA screening with 87% (76/87) undergoing the test. Of the 11 untested, four were offered screening and refused; two refused outright and two declined while awaiting insurance coverage. Of the remaining 7 untested, four women presented for problem visits and three had no charted explanation precluding screening. There was no differences by race (P=.8) or insurance type (P=.5). OBGYNs and Primary Care Providers ordered equal numbers of scans (38/76 for both, P=1.0). CONCLUSION: DEXA scan is the gold-standard for diagnosing osteoporosis and recommended by USPSTF, yet screening referrals are not universal for eligible women in resident clinics. Tailored education for residents regarding this infrequently seen demographic group is needed.
Abstract Objectives: Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients. Methods: From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self‐reported SBU. Those with SBU other than “always” were asked to participate. At baseline, participants answered a 9‐item series of situational SBU questions, each scored on a 5‐point Likert scale. SBU was defined as a continuous variable (9‐item average) and as a dichotomous variable (response of “always” across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5‐ to 7‐minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3‐month follow‐up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi‐square testing. Results: Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] ±11 years; 61% male). At baseline, the intervention and control groups had similar mean (±SD) SBU scores (2.8 [±1.1] vs. 2.6 [±1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow‐up. The intervention group had significantly greater improvement in mean (±SD) SBU scores than controls (0.76 [±0.91] vs. 0.34 [±0.88], p < 0.001). Also, SBU prevalence of “always” was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03). Conclusions: Participants receiving a brief motivational intervention reported higher SBU at follow‐up compared to controls. An ED‐based intervention may be useful to increase SBU.
