title: Fracture risk assessment after BMD examination: whose job is it, anyway?
abstract: Fracture risk assessments on bone mineral density reports guide family physicians' treatment decisions but are subject to inaccuracy. Qualitative analysis of interviews with 22 family physicians illustrates their pervasive questioning of reported assessment accuracy and independent assumption of responsibility for assessment. Assumption of responsibility is common despite duplicating specialists' work.
  
  
  BACKGROUND
  Fracture risk is the basis for recommendations of treatment for osteoporosis, but assessments on bone mineral density (BMD) reports are subject to known inaccuracies. This creates a complex situation for referring physicians, who must rely on assessments to inform treatment decisions. This study was designed to broadly understand physicians' current experiences with and preferences for BMD reporting; the present analysis focuses on their interpretation and use of the fracture risk assessments on reports, specifically
  
  
  METHODS
  A qualitative, thematic analysis of one-on-one interviews with 22 family physicians in Ontario, Canada was performed.
  
  
  RESULTS
  The first major theme identified in interview data reflects questioning by family physicians of reported fracture risk assessments' accuracy. Several major subthemes related to this included questioning of: 1) accuracy in raw bone mineral density measures (e.g., g/cm(2)); 2) accurate inclusion of modifying risk factors; and 3) the fracture risk assessment methodology employed. A second major theme identified was family physicians' independent assumption of responsibility for risk assessment and its interpretation. Many participants reported that they computed risk assessments in their practice to ensure accuracy, even when provided with assessments on reports.
  
  
  CONCLUSIONS
  Results indicate family physicians question accuracy of risk assessments on BMD reports and often assume responsibility both for revising and relating assessments to treatment recommendations. This assumption of responsibility is common despite the fact that it may duplicate the efforts of reading physicians. Better capture of risk information on BMD referrals, quality control standards for images and standardization of risk reporting may help attenuate some inefficiency.
authors.affiliation: Department of Physical Therapy, University of Toronto, 160-500 University Ave., M5G 1V7, Toronto, Ontario, Canada, s.allin@utoronto.ca.
authors.forename: S
authors.initials: S
authors.lastname: Allin
authors.forename: S
authors.initials: S
authors.lastname: Munce
authors.forename: L
authors.initials: L
authors.lastname: Carlin
authors.forename: D
authors.initials: D
authors.lastname: Butt
authors.forename: K
authors.initials: K
authors.lastname: Tu
authors.forename: G
authors.initials: G
authors.lastname: Hawker
authors.forename: J
authors.initials: J
authors.lastname: Sale
authors.forename: S
authors.initials: S
authors.lastname: Jaglal
mesh_terms: D001291:Attitude of Health Personnel; D015519:Bone Density / Q000502:physiology*; D005194:Family Practice / Q000458:organization & administration; D006801:Humans; D009864:Ontario; D010024:Osteoporosis / Q000175:diagnosis*; D058866:Osteoporotic Fractures / Q000209:etiology* / Q000503:physiopathology; D010819:Physician's Role / Q000523:psychology*; D010821:Physicians, Family / Q000523:psychology; D036301:Qualitative Research; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods / Q000592:standards