Article Figures & Data
Figures
- Figure 1.
Family physicians’ preferred ways to learn about the 2010 osteoporosis guidelines: N = 1019.
CME—continuing medical education, EMR—electronic medical record, PBSG—problem-based small group learning.
*Other comprises paper-based handouts, online webinar, or audit and feedback.
- Figure 2.
Physician agreement with current barriers to guideline use
EMR—electronic medical record.
*Agreement includes physicians who originally answered “strongly agree,” “agree,” or “somewhat agree.”
- Figure 3.
Physician agreement regarding barriers to implementing osteoporosis guidelines using an EMR tool
EMR—electronic medical record.
*Agreement includes physicians who originally answered “strongly agree,” “agree,” or “somewhat agree.”
Tables
CHARACTERISTICS N (%) Family practice model • Blended capitation (eg, family health networks, family health organizations) 362 (34.3) • Fee-for-service (eg, comprehensive care model, family health groups) 234 (22.2) • Blended salary (eg, community-sponsored family health teams) 169 (16.0) • Salaried model (eg, community health centres) 43 (4.1) • Complement-based base remuneration plus bonuses and incentives (rural northern physician group agreement) 10 (0.9) • Resident 12 (1.1) • No answer given 224 (21.3) Practice setting • Private office 608 (57.7) • Academic institution 133 (12.6) • Both private office and academic institution 88 (8.3) • No answer given 225 (21.3) Current EMR vendor • PS Suite EMR (Telus) 305 (28.9) • OSCAR EMR 128 (12.1) • Nightingale 100 (9.5) • Accuro EMR 65 (6.2) • Other 279 (26.5) • Not currently using EMRs 177 (16.8) EMR—electronic medical record.
- Table 2.
Rank-ordered list of osteoporosis diagnosis and treatment topics for which further education would be useful
TOPICS n/N (%)* Diagnosis related • Interpreting laboratory test results for secondary osteoporosis 756/882 (85.7) • What laboratory tests to order to rule out secondary osteoporosis 755/883 (85.5) • Interpreting BMD results 743/893 (83.2) • When to order lateral AP lumbar spine x-ray scan 734/884 (83.0) • When to order BMD testing 704/886 (79.5) • Interpreting lateral AP lumbar spine x-ray scan 679/872 (77.9) • Clinical examination for vertebral fracture 646/885 (73.0) Treatment related • Duration of pharmacotherapy 839/886 (94.7) • Adverse effects of pharmacotherapy 780/890 (87.6) • Types of pharmacotherapy 760/886 (85.8) • Dose of pharmacotherapy 705/887 (79.5) • Calcium dose 650/882 (73.7) • Vitamin D dose 622/869 (71.6) AP—anterior-posterior, BMD—bone mineral density.
↵* Percentages are based on the proportion of respondents who somewhat agreed, agreed, or strongly agreed with a statement regarding the need for education on a specific osteoporosis-related topic.
- Table 3.
Learning needs related to osteoporosis care and barriers to guideline implementation using EMR tools that were identified with open-ended questions
OPEN-ENDED QUESTION EXAMPLE QUOTATIONS What do you have a great deal of difficulty with regarding osteoporosis diagnosis and screening? Learning needs related to diagnosis and screening • Interpreting BMD reports, particularly for patients receiving treatment “Radiologists have started saying, ‘Cannot provide risk because patient is on therapy for osteoporosis.’ So, what do I do with this report?” • When to order a BMD test “I am currently not ordering BMD on a male patient over 65 years without any risk factors, as I don’t know what to do with the results if they have osteoporosis” • When to repeat BMD tests “Never quite sure when and how often to order repeat BMDs, especially for low-risk patients or those on bisphosphonates!” Learning needs related to treatment • Managing patients who are in the moderate-risk category “The high-risk and low-risk patients are easy … it’s those darn moderate-risk patients and trying to determine who require[s] treatment” • Prescribing pharmacotherapy for osteoporosis -Types of treatment and first-line therapies “Unbelievably confusing about who to treat with what and for how long!” -Duration of treatments and drug holidays “Duration of bisphosphonate therapy appears to be the Wild, Wild West of osteoporosis treatment … no one seems to know the optimal duration of bisphosphonate therapy” What do you feel are barriers to implementing guidelines using EMR tools? Too time consuming to learn how to use the tools “The biggest barrier is the first use. If someone showed me how to use my EMR to assess risk and evaluate if BMD is necessary, I think it would become part of my routine” Difficulty introducing new tools into EMR software “PS [Suite EMR] software is problematic with the introduction of new stamps and templates” Difficulty revising the tool when guidelines are revised and software is updated “EMR tools are great … but how do we keep these up to date as the guidelines change?” BMD—bone mineral density, EMR—electronic medical record.
