Engagement in Primary Prevention Program among Rural Veterans With Osteoporosis Risk.

JBMR Plus

VHA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Center for Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC) Veterans Affairs Iowa City VHA Health Care System Iowa City Iowa USA.

Published: October 2022

AI Article Synopsis

  • A virtual bone health team (BHT) was established to help manage osteoporosis risk among rural veterans aged 50 and older, using remote communication methods for screening and treatment.
  • Despite the program's design to facilitate screening, only about 25% of eligible veterans participated, with barriers including older age, marital status, and distance from services impacting enrollment.
  • Among those who were treated, factors linked to increased medication uptake included a history of falls, parental fracture history, current smoking status, and engagement in weight-bearing exercises, highlighting the influence of health beliefs and access on osteoporosis prevention efforts.

Article Abstract

A primary osteoporosis prevention program using a virtual bone health team (BHT) was implemented to comanage the care of rural veterans in the Mountain West region of the United States. The BHT identified, screened, and treated rural veterans at risk for osteoporosis using telephone and United States Postal Service communications. Eligibility was determined by regular use of Veterans Health Administration primary care, age 50 or older, and evidence of fracture risk. This study was conducted to identify demographic and clinical factors associated with the acceptance of osteoporosis screening and the initiation of medication where indicated. A cross-sectional cohort design ( = 6985) was utilized with a generalized estimating equation and logit link function to account for facility-level clustering. Fully saturated and reduced models were fitted using backward selection. Less than a quarter of eligible veterans enrolled in BHT's program and completed screening. Factors associated with a lower likelihood of clinic enrollment included being of older age, unmarried, greater distance from VHA services, having a copayment, prior fracture, or history of rheumatoid arthritis. A majority of veterans with treatment indication started medication therapy ( = 453). In this subpopulation, Fisher's exact test showed a significant association between osteoporosis treatment uptake and a history of two or more falls in the prior year, self-reported parental history of fracture, current smoking, and weight-bearing exercise. The BHT was designed to reduce barriers to screening; however, for this population cost and travel continue to limit engagement. The remarkable rate of medication initiation notwithstanding, low enrollment reduces the impact of this primary prevention program, and findings pertaining to fracture, smoking, and exercise imply that health beliefs are an important contributing factor. Efforts to identify and address barriers to osteoporosis screening and treatment, such as clinical factors, social determinants of health, and health beliefs, may pave the way for effective implementation of population bone health care delivery systems. Published 2022. This article is a U.S. Government work and is in the public domain in the USA. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549732PMC
http://dx.doi.org/10.1002/jbm4.10682DOI Listing

Publication Analysis

Top Keywords

prevention program
12
rural veterans
12
primary prevention
8
bone health
8
united states
8
clinical factors
8
factors associated
8
osteoporosis screening
8
health beliefs
8
veterans
6

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!