Patient Activation After DXA Result Notification (PAADRN)

• Osteoporotic prescribing rates at 12 weeks after DXA. [ Time Frame: 12 weeks after DXA ] [ Designated as safety issue: No ]
  We will use patient self-reports and pharmacy data to collect this information.
  
  
• Changes in Calcium/Vitamin D use from baseline to 12 and 52 weeks post DXA. [ Time Frame: Baseline and 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  
• Changes in smoking behaviors from baseline to 12 and 52 weeks post DXA. [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  Smoking frequency (Every day, Some days, or not at all)
  
  
• Changes in alcohol intake from baseline to 12 and 52 weeks post DXA [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  Number of drinks on a typical day
  
  
• Changes in weight bearing and strengthening exercise behaviors from baseline to 12 and 52 weeks post DXA [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  Frequency of weight-bearing and strengthening types of exercises in a week in the past month.
  
  
• Changes in satisfaction with bone-related care from baseline to 12 and 52 weeks post DXA [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  Satisfaction with timeliness of provider communication of DXA results, understanding of DXA results, understanding of available treatment options, information provided to make an informed decision, and overall satisfaction with care received for bones.
  
  
• Changes in health-related quality of life from baseline to 12 and 52 weeks post DXA [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  As measured by EQ-5D
  
  
• Changes in osteoporosis specific knowledge from baseline to 12 and 52 weeks post DXA. [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  As measured by "Osteoporosis and You"
  
  
• Cost of intervention [ Time Frame: 52 weeks after DXA ] [ Designated as safety issue: No ]
  
• Adherence to prescribed pharmacotherapy at 12 anbd 52 weeks post DXA [ Time Frame: 12 and 52 weeks post DXA ] [ Designated as safety issue: No ]
  This information will be collected from patient self reports and pharmacy data.
  
  

• Preference for self-care [ Time Frame: Baseline only ] [ Designated as safety issue: No ]
  As measured by the Krantz Health Opinion Survey
  
  
• Changes in osteoporosis attitudes and beliefs from baseline to 12 and 52 weeks post DXA. [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  As measured by a subscale of the "Osteoporosis Self-Efficacy Scale" and a subset of the "Osteoporosis Health Belief Scale"
  
  
• Changes in general patient activation from baseline to 12 and 52 weeks post DXA [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  As measured by six items from the Patient Activation Measure (PAM)-13
  
  
• Number of participants with complaints about intervention [ Time Frame: 11 months ] [ Designated as safety issue: Yes ]
  
• BMD result [ Time Frame: 1 week after DXA ] [ Designated as safety issue: No ]
  
• History of bone-related health concerns [ Time Frame: Baseline, 12 and 52 weeks after DXA ] [ Designated as safety issue: No ]
  History of fracture, osteopenia, osteoporosis, parental fracture history
  
  
• Sex [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Age [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Race [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Co-morbidities [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Reasons for failure to fill prescriptions [ Time Frame: Baseline, 12 and 52 weeks ] [ Designated as safety issue: No ]
  
• Insurance status [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Educational attainment [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  
• Health Literacy [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  As measured by the Single-Item Health Literacy Screener
  
  
• Numeracy [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  As measured by the Subjective Numeracy Scale
  
  

Bone mineral density (BMD) peaks in early adulthood and declines progressively with aging. As BMD declines from normal, to low (formerly called osteopenia), to osteoporosis, risk of fractures progressively increases. In an effort to prevent bone loss and reduce fracture risk, most widely accepted guidelines including the U.S. Preventive Services Task Force and Surgeon General's Office now recommend BMD screening of older adults using dual energy x-ray absorptiometry (DXA). The rationale for screening is that patients and their providers will use DXA results as a "cue to action" and take necessary steps to enhance bone health through lifestyle modification (e.g., weight bearing exercise), Calcium/Vitamin D supplementation, and pharmacotherapy when indicated. However, multiple studies have demonstrated that patients and providers often fail take recommended actions following DXA testing, thus defeating much of the purpose of screening. Over the past five years we have systematically developed and pilot tested a low-cost and practical patient activation intervention based upon the Health Belief Model. The intervention consists of the DXA scanning center mailing each patient a customized letter containing the results of their DXA scan plus educational information about osteoporosis, supplemented by a follow-up phone call from a nurse educator. Preliminary studies have demonstrated that the intervention is well received by both patients and providers and enhances bone-related quality of care. The overarching objective of the current proposal is to rigorously examine the impact of our patient activation intervention on bone-related quality of care in adults undergoing screening DXA scans through a randomized-controlled trial conducted at three study sites. In addition, we will examine the real-world costs associated with our intervention and the impact of our intervention on the overall cost-effectiveness of BMD screening. We hypothesize that the activation intervention will increase optimization of Calcium/Vitamin D intake, enhance use of pharmacotherapy when indicated, will improve patient satisfaction with their bone-related healthcare, and improve patients' osteoporosis specific knowledge when compared with usual care