title: Comparison of interactive voice response, patient mailing, and mailed registry to encourage screening for osteoporosis: a randomized controlled trial.
abstract: Guidelines recommend screening for osteoporosis with bone mineral density (BMD) testing in menopausal women, particularly those with additional risk factors for fracture. Many eligible women remain unscreened. This randomized study demonstrates that a single outreach interactive voice response phone call improves rates of BMD screening among high-risk women age 50-64.
  
  
  BACKGROUND
  Osteoporotic fractures are a major cause of disability and mortality. Guidelines recommend screening with BMD for menopausal women, particularly those with additional risk factors for fracture. However, many women remain unscreened. We examined whether telephonic interactive voice response (IVR) or patient mailing could increase rates of BMD testing in high risk, menopausal women.
  
  
  METHODS
  We studied 4,685 women age 50-64 years within a not-for-profit health plan in the United States. All women had risk factors for developing osteoporosis and no prior BMD testing or treatment for osteoporosis. Patients were randomly allocated to usual care, usual care plus IVR, or usual care plus mailed educational materials. To avoid contamination, patients within a single primary care physician practice were randomized to receive the same intervention. The primary endpoint was BMD testing at 12 months. Secondary outcomes included BMD testing at 6 months and medication use at 12 months.
  
  
  RESULTS
  Mean age was 57 years. Baseline demographic and clinical characteristics were similar across the three study groups. In adjusted analyses, the incidence of BMD screening was 24.6% in the IVR group compared with 18.6% in the usual care group (P < 0.001). There was no difference between the patient mailing group and the usual care group (P = 0.3).
  
  
  CONCLUSIONS
  In this large community-based randomized trial of high risk, menopausal women age 50-64, IVR, but not patient mailing, improved rates of BMD screening. IVR remains a viable strategy to incorporate in population screening interventions.
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA, lheyworth@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Heyworth
authors.forename: K
authors.initials: K
authors.lastname: Kleinman
authors.forename: S
authors.initials: S
authors.lastname: Oddleifson
authors.forename: L
authors.initials: L
authors.lastname: Bernstein
authors.forename: J
authors.initials: J
authors.lastname: Frampton
authors.forename: M
authors.initials: M
authors.lastname: Lehrer
authors.forename: K
authors.initials: K
authors.lastname: Salvato
authors.forename: T W
authors.initials: TW
authors.lastname: Weiss
authors.forename: S R
authors.initials: SR
authors.lastname: Simon
authors.forename: M
authors.initials: M
authors.lastname: Connelly
mesh_terms: D015519:Bone Density; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011177:Postal Service; D049250:Speech Recognition Software; D013689:Telephone; D014481:United States; D014584:User-Computer Interface