Alexandra Papaioannou (McMaster University, Hamilton); Peter Lin (Canadian Heart Research Center); Heather Frame (Victoria Hospital, Winnipeg); Sidney Feldman (University of Toronto, Toronto); Christopher Sherwood (Amgen Canada Inc.); Suzanne Morin (McGill University, Montreal)
In 2010, Osteoporosis Canada (OC) published updated clinical guidelines. The guidelines highlight a shift toward assessing the risk of fragility fracture using clinical risk factors in addition to bone mineral density (BMD, rather than treating based solely on BMD results. The guidelines incorporate a validated and updated 10-year Absolute Fracture Risk (AFR) model. While the earlier AFR model (2005) was developed in partnership with OC and the Canadian Association of Radiologists, there were limited educational initiatives supporting its use by family practice physicians (FPs).
A survey of Canadian FPs, conducted before release of the 2010 guidelines, assessed awareness and use of AFR models. Results guided the development of FP education initiatives supporting use of the 2010 guidelines and updated AFR model.
• 68% were aware of and/or used AFR tools. However:
o 58% rely on DXA alone to diagnose osteoporosis
o Only 18% of FPs routinely ask patients if they have experienced a recent fracture
• 56% ‘very strongly’ agreed that they would use guidelines if they were quick/easy to use
o For 44%, including a point-of-care treatment algorithm (electronic and paper) would facilitate use of guidelines
Based on these results, a multifaceted-educational program was developed involving four cohorts, to assess the impact of various educational interventions:
- Full educational intervention (pre-education survey, didactic education, practice assessment and electronic AFR point-of-care tool)
- Partial educational intervention (pre-education survey, didactic education)
- Pre-education survey
- No interventionA post-intervention survey will be conducted to reassess change in awareness and behaviours.
Prior to the release of the 2010 Osteoporosis Canada (OC) guidelines, physician awareness and use of earlier fracture risk stratification tools for osteoporosis has been limited, particularly regarding awareness of fracture as a key risk factor among older women. With the release of the new guidelines, a multifaceted educational program has been designed for Canadian family practice physicians (FPs). FPs exposed to some or all elements of the program will be tested to evaluate their awareness, understanding, and use of the new OC guidelines.