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The Contribution of Patient, Primary Care Physician, and Primary Care Clinic Factors to Good Bone Health Care

Author

Perm J. 2021 Jan;25:1-3. doi: 10.7812/TPP/20.095.

Douglas W Roblin 1Peter Cram 2 3Yiyue Lou 4Stephanie W Edmonds 5Sylvie F Hall 6Michael P Jones 7Kenneth G Saag 8Nicole C Wright 9Lee F Cromwell 10Brandi E Robinson 10Fredric D Wolinsky 11PAADRN Investigators

Author Information

1 Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD.

2 Faculty of Medicine, University of Toronto, Toronto, Canada.

3 Division of General Internal Medicine and Geriatrics, Mt. Sinai/UHN Hospitals, Toronto, Canada.

4 Vertex Pharmaceuticals, Boston, MA.

5 College of Nursing, University of Iowa, Iowa City, IA.

6 Clinical Pharmacy Services, Bellevue Hospital, New York, NY.

7 Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA.

8 Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.

9 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.

10 Center for Research and Evaluation, Kaiser Permanente, Atlanta, GA.

11 Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA.

Abstract

Background/objective: Patient, provider, and system factors can contribute to chronic care management and outcomes. Few studies have examined these multilevel associations with osteoporosis care and outcomes. We examined how key process and structural factors at the patient, primary care physician (PCP), and primary care clinic (PCC) levels were associated with guideline concordant osteoporosis pharmacotherapy, daily calcium intake, vitamin D supplementation, and weekly exercise sessions at 52 weeks following enrollment in a cluster randomized controlled trial.

Methods: We conducted a secondary analysis of observational data from 1 site of the trial. The study sample included 1996 men and women ≥ 50 years of age at the time of recruitment following completion of a dual-energy x-ray absorptiometry (DXA) scan and who had complete data at baseline and 52 weeks. Our primary independent variable was "relationship continuity": the DXA-ordering provider was the patient's PCP. Hierarchical linear and logistic regression accounted for patient, provider, and primary care clinic characteristics.

Results: In multivariable regression analyses, relationship continuity (ie, the PCP ordered the study DXA) was associated with higher average daily calcium intake and likelihood of vitamin D supplementation at 52 weeks. No PCP or primary care clinic factors were associated with osteoporosis care.

Conclusions: The relationship continuity, in which the provider ordering a DXA is the patient's PCP and therefore also presents the results of a DXA, may help to promote patient behaviors associated with good bone health.