Research article

Optimizing care in osteoporosis: The Canadian quality circle project

George Ioannidis^1,8 , Lehana Thabane^2,3,8 , Amiram Gafni^2,8 , Anthony Hodsman^4,8 , Brent Kvern^5,8 , Dan Johnstone^6,8 , Nathalie Plumley^6,8 , Lena Salach^7,8 , Famida Jiwa^7,8 , Jonathan D Adachi^1,8 and Alexandra Papaioannou^1,8

¹Department of medicine, McMaster University, Hamilton, Ontario, Canada

²Department of clinical epidemiology and biostatistics, McMaster University, Hamilton, Ontario, Canada

³Director of biostatistics at the Father Sean O'Sullivan Research Centre and Centre for Evaluation of Medicines at St Joseph's Healthcare in Hamilton, Hamilton, Ontario Canada

⁴Department of medicine, University of Western Ontario, London, Ontario, Canada

⁵Department of family medicine, University of Manitoba, Winnipeg, Manitoba, Canada

⁶Procter & Gamble Pharmaceuticals, Toronto, Ontario, Canada

⁷Research and Professional Development, Ontario College of Family Physicians, Toronto, Ontario, Canada

⁸Osteoporosis Canada, Toronto, Ontario, Canada

author email corresponding author email

BMC Musculoskeletal Disorders 2008, 9:130doi:10.1186/1471-2474-9-130

Published:	1 October 2008

Abstract

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 1^st 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).

Conclusion

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.