Barriers to and facilitators of osteoporosis investigation and treatment among older community-dwelling women in Ontario:  Application of a health services utilization conceptual framework.
Published: 2006
Language: eng
Number of pages: 197
ISBN-13: 9780494218914
Description: Background. Osteoporosis (OP) is a major public health problem leading to fractures causing considerable morbidity and health care costs. Early identification of those at high risk for OP-related fractures is possible by measurement of bone mineral density using dual-energy X-ray absorptiometry (DXA). Primary objectives. (1) To estimate the proportion of older women being investigated for OP by DXA testing and being treated for fracture prevention (taking a bisphosphonate, calcitonin and/or raloxifene), and (2) To identify the barriers and facilitators to OP investigation and treatment using a conceptual framework of health services utilization. Methods. Community-dwelling women aged 65-90 years residing within two regions of Ontario, and able to complete the standardized telephone interview, were eligible. Data collection began in May 2003 and lasted one year. Potential correlates were grouped by type as: predisposing characteristics, enabling resources or need factors. Hierarchical entry of variables, grouped by type, was used in model building with logistic regression.  Results. Of the 871 participants (72% response rate), 55% had been investigated by DXA testing and 20% were receiving treatment. Adjusting for need factors, significant inequities in access to DXA testing and OP treatment were identified. Barriers (lack of enabling resources) to DXA testing included poor regional access, lower income and having a male primary care provider. Factors facilitating DXA testing (predisposing characteristics) included higher education, younger age and having preventive health care check-ups. Most of the variation associated with OP treatment was related to need factors, primarily identified by DXA test results. In addition to inequities associated with suboptimal DXA testing, barriers to OP treatment included lack of private drug coverage and shorter duration of relationship with primary care providers. Primary language being English, however, was identified as a facilitator to OP treatment. Conclusions. Multiple level preventive health care interventions are needed to reduce inequities in OP care. These should target educating older women about OP diagnosis by DXA and effective treatment options, and providing resources to physicians to better enable them to manage OP and communicate the results of DXA testing and the need for treatment to reduce fracture risk with their patients.
Notes: Source: Dissertation Abstracts International, Volume: 68-01, Section: B, page: 0200.

Thesis (Ph.D.)--University of Toronto, 2006.

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