Commentary
The article provides a description of a “health promotion outreach system” designed to “improve the delivery of preventive and chronic disease care in the outpatient setting.”1
Specifically, this outreach system was developed to increase DXA testing of bone density in women between the ages of 65 and 79 who were patients in an academic ambulatory medical practice. The recommendation of the US Preventive Services Task Force (USPSTF) is that DXA screening should routinely begin for postmenopausal women at age 65, and at age 60 for those who are at increased risk for osteoporotic fractures (e.g., low weight and no current hormone replacement therapy).2 Women aged 80 and over were excluded from the study because primary care providers (PCPs) preferred to see them prior to a DXA referral, assuming they might have more comorbidities than younger women. Women were also excluded if they were currently taking a bisphosphonate or had active cancer or a terminal diagnosis.
The authors make a case for the importance of the study, noting that the disability, mortality, and direct care costs associated with osteoporotic fractures could be reduced if screening were increased and treatment begun to maintain or increase bone density. They note that 50% of women aged 50 and older will have a future osteoporosis-related fracture.3 Further evidence pointing out the incidence and the issues associated with osteoporotic fractures is available and compelling.4,5
Prior to implementation of the intervention, it was approved by all of the PCPs in the system. An invitation letter was sent to 564 eligible patients that informed them of the USPSTF recommendations and encouraged them to call for a DXA appointment. Along with the letter, a prepaid postcard was included that individuals could return to indicate if they had had a previous DXA outside this agency, no longer received primary health care within this system, were not interested in receiving a DXA, or would like to be called at a given time and number. If there was no response to the first letter within two weeks, the coordinator called the patients up to three times over an eight-week period. If no response was received, a voice message was left only the first time. If the woman was reached, the coordinator reviewed the DXA recommendations and scheduled an appointment, if this was desired. An electronic order for the DXA was then requested from the PCP. When the DXA results were received, the PCP decided whether to follow up by mail, phone, or an office visit. A call center was available for patients to request a callback.
