Cargando…

Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study

Rates of postfracture DXA and pharmacotherapy appear to be declining despite their known benefits in fracture reduction. We sought to identify factors associated with osteoporosis care among male veterans aged 50 years and older after hip fracture and to evaluate trends in rates of care with an obse...

Descripción completa

Detalles Bibliográficos
Autores principales: Solimeo, Samantha L, McCoy, Kimberly, Reisinger, Heather Schacht, Adler, Robert A, Vaughan Sarrazin, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808329/
https://www.ncbi.nlm.nih.gov/pubmed/31667454
http://dx.doi.org/10.1002/jbm4.10198
_version_ 1783461754079019008
author Solimeo, Samantha L
McCoy, Kimberly
Reisinger, Heather Schacht
Adler, Robert A
Vaughan Sarrazin, Mary
author_facet Solimeo, Samantha L
McCoy, Kimberly
Reisinger, Heather Schacht
Adler, Robert A
Vaughan Sarrazin, Mary
author_sort Solimeo, Samantha L
collection PubMed
description Rates of postfracture DXA and pharmacotherapy appear to be declining despite their known benefits in fracture reduction. We sought to identify factors associated with osteoporosis care among male veterans aged 50 years and older after hip fracture and to evaluate trends in rates of care with an observational cohort design using US Department of Veterans Affairs’ (VA) inpatient, pharmacy, and outpatient encounters and Centers for Medicare and Medicaid Services outpatient pharmacy claims (2007 to 2014) from men aged 50 years and older treated for hip fracture (N = 7317). We used the Cox proportional hazards model with random effects for the admitting facility. A sensitivity analysis was performed for a subset of patients aged 65 to 99 dually enrolled in Medicare ( N = 5821). Overall, approximately 13% of patients had evidence of osteoporosis care within one year of fracture. In the adjusted model, rural residence was associated with lower likelihood of care, and several comorbidities were associated with higher likelihood of receiving care. In sensitivity analyses of patients dually enrolled in Medicare, rural residence remained associated with lower likelihood of osteoporosis care. Overall rates of care decreased over time, but rates of DXA in the VA remained stable. These findings highlight the ongoing problem of low rates of postfracture care among a population with the highest risk of future fracture and its associated morbidity and mortality. The rural disparity in care and differences in rates of care across healthcare delivery systems illustrates the importance of healthcare delivery systems in promoting pharmacotherapy and DXA after sentinel events. Because the VA removes a majority of cost barriers to care, this integrated healthcare system may outperform the private sector in access to care. However, declining rates of pharmacotherapy imply knowledge gaps that undermine quality care. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
format Online
Article
Text
id pubmed-6808329
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-68083292019-10-30 Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study Solimeo, Samantha L McCoy, Kimberly Reisinger, Heather Schacht Adler, Robert A Vaughan Sarrazin, Mary JBMR Plus Original Articles Rates of postfracture DXA and pharmacotherapy appear to be declining despite their known benefits in fracture reduction. We sought to identify factors associated with osteoporosis care among male veterans aged 50 years and older after hip fracture and to evaluate trends in rates of care with an observational cohort design using US Department of Veterans Affairs’ (VA) inpatient, pharmacy, and outpatient encounters and Centers for Medicare and Medicaid Services outpatient pharmacy claims (2007 to 2014) from men aged 50 years and older treated for hip fracture (N = 7317). We used the Cox proportional hazards model with random effects for the admitting facility. A sensitivity analysis was performed for a subset of patients aged 65 to 99 dually enrolled in Medicare ( N = 5821). Overall, approximately 13% of patients had evidence of osteoporosis care within one year of fracture. In the adjusted model, rural residence was associated with lower likelihood of care, and several comorbidities were associated with higher likelihood of receiving care. In sensitivity analyses of patients dually enrolled in Medicare, rural residence remained associated with lower likelihood of osteoporosis care. Overall rates of care decreased over time, but rates of DXA in the VA remained stable. These findings highlight the ongoing problem of low rates of postfracture care among a population with the highest risk of future fracture and its associated morbidity and mortality. The rural disparity in care and differences in rates of care across healthcare delivery systems illustrates the importance of healthcare delivery systems in promoting pharmacotherapy and DXA after sentinel events. Because the VA removes a majority of cost barriers to care, this integrated healthcare system may outperform the private sector in access to care. However, declining rates of pharmacotherapy imply knowledge gaps that undermine quality care. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. John Wiley and Sons Inc. 2019-06-27 /pmc/articles/PMC6808329/ /pubmed/31667454 http://dx.doi.org/10.1002/jbm4.10198 Text en © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Solimeo, Samantha L
McCoy, Kimberly
Reisinger, Heather Schacht
Adler, Robert A
Vaughan Sarrazin, Mary
Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title_full Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title_fullStr Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title_full_unstemmed Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title_short Factors Associated With Osteoporosis Care of Men Hospitalized for Hip Fracture: A Retrospective Cohort Study
title_sort factors associated with osteoporosis care of men hospitalized for hip fracture: a retrospective cohort study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808329/
https://www.ncbi.nlm.nih.gov/pubmed/31667454
http://dx.doi.org/10.1002/jbm4.10198
work_keys_str_mv AT solimeosamanthal factorsassociatedwithosteoporosiscareofmenhospitalizedforhipfracturearetrospectivecohortstudy
AT mccoykimberly factorsassociatedwithosteoporosiscareofmenhospitalizedforhipfracturearetrospectivecohortstudy
AT reisingerheatherschacht factorsassociatedwithosteoporosiscareofmenhospitalizedforhipfracturearetrospectivecohortstudy
AT adlerroberta factorsassociatedwithosteoporosiscareofmenhospitalizedforhipfracturearetrospectivecohortstudy
AT vaughansarrazinmary factorsassociatedwithosteoporosiscareofmenhospitalizedforhipfracturearetrospectivecohortstudy