Evidence map›Paper›PMID 27363400›Full record

Trial reportOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2016

Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial.

P Cram, F D Wolinsky, Y Lou, S W Edmonds, S F Hall, D W Roblin, N C Wright, M P Jones, K G Saag, PAADRN Investigators

Registry-linked trialAbstract readRandomized Controlled TrialPragmatic Clinical Trial
In one paragraph

Trial report in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01507662 (Patient Activation After DXA Result Notification), which is not on this map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01507662 nacompletednot on this map

Patient Activation After DXA Result Notification

TypeinterventionalSponsorFredric D WolinskyRan2012 to 2015Enrolled7,749ConditionsOsteoporosis, Bone Diseases, MetabolicArmsBone Mineral Density Result Letter and Bone Health Brochure
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020
    Pooled it
  2. How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2018
    Pooled it
  3. Trial
  4. Sex differences in osteoporosis self-efficacy among community-residing older adults presenting for DXA.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019
    Trial
  5. Evaluation of a Multimodal, Direct-to-Patient Educational Intervention Targeting Barriers to Osteoporosis Care: A Randomized Clinical Trial.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2018
    Trial
  6. Trial
  7. The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017
    Trial
  8. The cost of a patient activation intervention for achieving successful outcomes: results from the PAADRN randomized controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017
    Trial
  9. Trial
  10. Trial
  11. Trial
  12. Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial.Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry
    Trial
  13. Review
  14. Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022
    Review
  15. Pharmacotherapy decisions among postmenopausal women attending a group medical consultation or a one-on-one specialist consultation at an osteoporosis center: an observational cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021
    Observational
  16. Article
  17. Review
  18. Pragmatic Clinical Trials in Osteoporosis.Current osteoporosis reports · 2019
    Review
  19. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

P CramDepartment of Medicine, University of Toronto, Toronto, Canada.
F D WolinskyDivision of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. fredric-wolinsky@uiowa.edu.
Y LouDepartment of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
S W EdmondsDivision of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
S F HallDivision of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
D W RoblinKaiser Permanente, Atlanta, GA, 30305, USA.
N C WrightDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
M P JonesDepartment of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
K G SaagDivision of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
PAADRN Investigators

Funding

A Patient Activation Intervention to Enhance Bone HealthR01AG033035 · NIA · UNIVERSITY OF IOWA · PI WOLINSKY, FREDRIC D · 2010 to 2014
$7.0M
UAB K12 in Patient Centered Outcomes ResearchK12HS023009 · AHRQ · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI SAAG, KENNETH G · 2014 to 2018
$4.0M
Mid-Career Investigator Award (for Kenneth G. Saag, MD, MSc)K24AR052361 · NIAMS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI SAAG, KENNETH G · 2005 to 2014
$1.7M
Building Musculoskeletal Outcomes Research at the University of IowaK24AR062133 · NIAMS · UNIVERSITY OF IOWA · PI CRAM, PETER M · 2012 to 2016
$594k
AHRQ HHS K12 HS023009NIAMS NIH HHS K24 AR052361NIAMS NIH HHS K24 AR062133NIA NIH HHS R01 AG033035
6 · The paper itself

Abstract

Patients often do not know or understand their bone density test results, and pharmacological treatment rates are low. In a clinical trial of 7749 patients, we used a tailored patient-activation result letter accompanied by a bone health brochure to improve appropriate pharmacological treatment. Treatment rates, however, did not improve.

introductionPatients often do not know or understand their dual-energy x-ray absorptiometry (DXA) test results, which may lead to suboptimal care. We tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline-concordant pharmacological treatment compared to usual care only.

methodsWe conducted a randomized, controlled, double-blinded, pragmatic clinical trial at three health care centers in the USA. We randomized 7749 patients ≥50 years old and presenting for DXA between February 2012 and August 2014. The primary clinical endpoint at 12 and 52 weeks post-DXA was receiving guideline-concordant pharmacological treatment. We also examined four of the steps along the pathway from DXA testing to that clinical endpoint, including (1) receiving and (2) understanding their DXA results and (3) having subsequent contact with their provider and (4) discussing their results and options.

resultsMean age was 66.6 years, 83.8 % were women, and 75.3 % were non-Hispanic whites. Intention-to-treat analyses revealed that guideline-concordant pharmacological treatment was not improved at either 12 weeks (65.1 vs. 64.3 %, p = 0.506) or 52 weeks (65.2 vs. 63.8 %, p = 0.250) post-DXA, even though patients in the intervention group were more likely (all p < 0.001) to recall receiving their DXA results letter at 12 weeks, correctly identify their results at 12 and 52 weeks, have contact with their provider at 52 weeks, and have discussed their results with their provider at 12 and 52 weeks.

conclusionA tailored DXA result letter and educational brochure failed to improve guideline-concordant care in patients who received DXA.

Indexed as

Bone DensityHealth Knowledge, Attitudes, PracticePatient Education as TopicAbsorptiometry, PhotonAgedBone and BonesBone Density Conservation AgentsFemaleHumansMaleOsteoporosisPractice Guidelines as TopicWhite PeopleBone Density Conservation AgentsAgingClinical trialsDXAOsteoporosisScreening

Identifiers

PMID27363400
PMCPMC5572571

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.