Optimizing care in osteoporosis: the Canadian quality circle project.
BACKGROUND
While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines.


METHODS
The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.


RESULTS
After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7).


CONCLUSIONS
Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.
Ioannidis
George
G
Department of medicine, McMaster University, Hamilton, Ontario, Canada. g.ioannidis@sympatico.ca
Thabane
Lehana
L
Gafni
Amiram
A
Hodsman
Anthony
A
Kvern
Brent
B
Johnstone
Dan
D
Plumley
Nathalie
N
Salach
Lena
L
Jiwa
Famida
F
Adachi
Jonathan D
JD
Papaioannou
Alexandra
A
D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002170:Canada; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008403:Mass Screening; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D010821:Physicians, Family / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012307:Risk Factors