Family physicians' personal and practice characteristics that are associated with improved utilization of bone mineral density testing and osteoporosis medication prescribing.

Family physicians' personal and practice characteristics may influence how osteoporosis is managed. Thus, we evaluated the impact of family physicians' personal and practice characteristics on the appropriate use of bone mineral density testing and osteoporosis therapy. The physician questionnaire assessed 13 personal and practice characteristics of the physicians. The patient questionnaire was used to collect data to ascertain how family physicians managed osteoporosis. A total of 225 family physicians from 7 provinces across Canada completed both the physician and patient questionnaires. The family physicians evaluated a total of 5601 patients. The generalized estimating equations technique was utilized to model the associations between family physicians' personal and practice characteristics and appropriate use of bone mineral density testing and osteoporosis therapy. Odds ratios (OR) and corresponding 95% confidence intervals (CI) are reported. Findings indicated that female family physicians have higher odds of administering appropriate bone density testing compared to male family physicians (OR: 1.28; 95% CI: 1.05, 1.55), and that physicians who have hospital privileges (OR: 0.77; 95% CI: 0.62, 0.97) and who graduated more recently from medical school (OR: 0.87; 95% CI: 0.77, 0.99) have lower odds of administering appropriate bone mineral density tests. Physicians who use electronic health records have higher odds of administering appropriate therapy (OR: 1.30; 95% CI: 1.06, 1.59) as compared to physicians who do not use them. Several family physicians' personal and practice characteristics are associated with appropriate utilization of bone mineral density testing and therapy. The education of both clinicians and policy makers regarding these new insights may translate to enhanced individual practices and an improved overall health care system to optimize the environment for managing osteoporosis.

[1]  A. Gafni,et al.  Canadian Quality Circle pilot project in osteoporosis: rationale, methods, and feasibility. , 2007, Canadian family physician Medecin de famille canadien.

[2]  Allan H. Goroll,et al.  Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care , 2007, Journal of General Internal Medicine.

[3]  Michael Gardam,et al.  The impact of physician training and experience on the survival of patients with active tuberculosis , 2006, Canadian Medical Association Journal.

[4]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[5]  Robert E Harbaugh,et al.  Surgeon Volume and Operative Mortality in the United States. , 2004, Neurosurgery.

[6]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[7]  Anne F. Kittler,et al.  A cost-benefit analysis of electronic medical records in primary care. , 2003, The American journal of medicine.

[8]  T. Koepsell,et al.  Primary care delivery is associated with greater physician experience and improved survival among persons with AIDS , 2003, Journal of General Internal Medicine.

[9]  Cheng Cheng,et al.  Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. , 2002, JAMA.

[10]  S. Gabriel,et al.  Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population‐Based Study , 2002, Journal of the American Geriatrics Society.

[11]  Ethan A Halm,et al.  Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature , 2002, Annals of Internal Medicine.

[12]  A. Juby,et al.  Evaluation of Osteoporosis Treatment in Seniors after Hip Fracture , 2002, Osteoporosis International.

[13]  Jillian T Henderson,et al.  Physician Gender Effects on Preventive Screening and Counseling: An Analysis of Male and Female Patients’ Health Care Experiences , 2001, Medical care.

[14]  A. Russell,et al.  Osteoporosis follow-up after wrist fractures following minor trauma. , 2001, Archives of internal medicine.

[15]  David W. Bates,et al.  Research Paper: Using Computerized Data to Identify Adverse Drug Events in Outpatients , 2001, J. Am. Medical Informatics Assoc..

[16]  J. Paterson,et al.  Role of family physicians in hospitals. Did it change between 1977 and 1997? , 2001, Canadian family physician Medecin de famille canadien.

[17]  Jonathan M. Teich,et al.  Identifying hospital admissions due to adverse drug events using a computer‐based monitor , 2001, AMIA.

[18]  J. Selby,et al.  Effect of physician and patient gender concordance on patient satisfaction and preventive care practices , 2000, Journal of General Internal Medicine.

[19]  J M Rothschild,et al.  Guidelines and decision support help improve image utilization. , 2000, Diagnostic imaging.

[20]  R. Goeree,et al.  Mortality, Independence in Living, and Re-fracture, One Year Following Hip Fracture in Canadians , 2000 .

[21]  J. Eisman,et al.  Mortality after all major types of osteoporotic fracture in men and women: an observational study , 1999, The Lancet.

[22]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[23]  P J Catalano,et al.  Goodness-of-fit for GEE: an example with mental health service utilization. , 1999, Statistics in medicine.

[24]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[25]  Andrew D Oxman,et al.  Closing the gap between research and practice : an overview of systematic reviews of interventions to promote the implementation of research findings , 2011 .

[26]  P. Coyte,et al.  Current and projected rates of hip fracture in Canada. , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[27]  Julie M. Fiskio,et al.  Automated evidence-based critiquing of orders for abdominal radiographs: impact on utilization and appropriateness. , 1997, Journal of the American Medical Informatics Association : JAMIA.

[28]  S. Cummings,et al.  Epidemiology and predictors of fractures associated with osteoporosis. , 1997, The American journal of medicine.

[29]  R. Josse,et al.  Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 1. Introduction. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[30]  H. Britt,et al.  The sex of the general practitioner: a comparison of characteristics, patients, and medical conditions managed. , 1996, Medical care.

[31]  T. Koepsell,et al.  Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival. , 1996, The New England journal of medicine.

[32]  J. Robbins,et al.  The Influence of Gender on Physician Practice Style , 1995, Medical care.

[33]  Judith A. Hall,et al.  Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[34]  C. Clancy,et al.  Physician Gender Bias in Clinical Decisionmaking: Screening for Cancer in Primary Care , 1993, Medical care.

[35]  J. Bensing,et al.  Gender Differences in Practice Style: A Dutch Study of General Practitioners , 1993, Medical care.

[36]  C. Cooper,et al.  Perspective how many women have osteoporosis? , 1992, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[37]  C J McDonald,et al.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. , 1990, The New England journal of medicine.

[38]  R. Arnold,et al.  Taking care of patients--does it matter whether the physician is a woman? , 1988, The Western journal of medicine.

[39]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[40]  L. Melton,et al.  Influence of fracture criteria on the outcome of a randomized trial of therapy , 2007, Osteoporosis International.

[41]  K. Bertakis,et al.  Physician gender, patient gender, and primary care. , 2003, Journal of women's health.

[42]  Jacques P. Brown,et al.  2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[43]  A. Papaioannou,et al.  Lengthy Hospitalization Associated with Vertebral Fractures Despite Control for Comorbid Conditions , 2001, Osteoporosis International.

[44]  P. Shea,et al.  Role of family physicians in hospitals , 2001 .

[45]  G. Hawker,et al.  Use of Bone Densitometry by Ontario Family Physicians , 2000, Osteoporosis International.

[46]  L. J. Melton.  Evidence-based assessment of pharmaceutical interventions. , 1998, Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA.

[47]  A. J. Orzano,et al.  Gender concordance between family practice residents and diagnoses in an ambulatory setting. , 1995, Family medicine.

[48]  D. Merrithew.  Preventive care for women--does the sex of the physician matter? , 1994, The New England journal of medicine.

[49]  F. C. Zapffe.  The Association of American Medical Colleges , 1938 .