C Roux1,2,3, G Baron4,5,6, K Briot7,5, B Roux8, B Cortet9,10, T Thomas11,12. 1. Paris Descartes University, Paris, France. christian.roux@aphp.fr. 2. Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27, Rue du Faubourg St Jacques, 75014, Paris, France. christian.roux@aphp.fr. 3. INSERM UMR1153, Paris, France. christian.roux@aphp.fr. 4. Paris Descartes University, Paris, France. 5. INSERM UMR1153, Paris, France. 6. Biostatistics and Clinical Epidemiology Center - Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 7. Department of Rheumatology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27, Rue du Faubourg St Jacques, 75014, Paris, France. 8. Fast 4 - Contract Research Organisation, Nîmes, France. 9. Department of Rheumatology, Lille 2 - University, CHRU, Lille, France. 10. EA 4490, Lille, France. 11. Department of Rheumatology, CHU, Saint-Etienne University, Saint-Etienne, France. 12. INSERM U1059, Saint-Etienne, France.
Abstract
Using case vignette methodology, this study shows that only 4% of patients are maintained on oral bisphosphonates over 5 years, and prescribers switch or stop the treatment in 20-30% of cases at each visit. There are few determinants of these changes. More information on appropriate follow-up could help in patients' management. INTRODUCTION: Persistence to oral bisphosphonates, the most commonly prescribed anti-osteoporotic treatments, is low. The aim of this study was to evaluate the role of rheumatologists on the treatment patterns, and to assess the determinants of treatment changes. METHODS: We used the methodology of case vignettes with the participation of 142 rheumatologists. Three baseline clinical vignettes were presented: (1) the physician was asked to indicate the most appropriate period to schedule the next visit over 5 years, (2) the physician was tested about parameters for follow-up (including traps), and (3) various results (both clinical, biological, densitometric, and radiological) were given by random and analyzed as determinants of treatment changes. RESULTS: The study allowed assessment of 426 virtual clinical cases. Clinical examinations, patient's height, inquiries about falls, and adherence to treatment were deemed necessary in > 90% of cases. Bone mineral density was measured in 22, 40, and 71% of cases at 2, 3, and 5 years, respectively. Dental follow-up was recommended in less than 25% of cases. Only 4.2% of patients were maintained on the same treatment at 5 years, and a change of treatment (stop or switch) occurs in 20-30% of cases at each visit. Significant determinants were adherence to treatment, serum C-terminal crosslinking telopeptide of type 1 collagen (CTX) value, change in patient's height, and the occurrence of an incident vertebral fracture. CONCLUSION: Our study shows that maintenance of oral bisphosphonate in postmenopausal women managed by rheumatologists is low; there are few determinants of these changes and more information on appropriate follow-up could help in patients' management.
Using case vignette methodology, this study shows that only 4% of patients are maintained on oral bisphosphonates over 5 years, and prescribers switch or stop the treatment in 20-30% of cases at each visit. There are few determinants of these changes. More information on appropriate follow-up could help in patients' management. INTRODUCTION: Persistence to oral bisphosphonates, the most commonly prescribed anti-osteoporotic treatments, is low. The aim of this study was to evaluate the role of rheumatologists on the treatment patterns, and to assess the determinants of treatment changes. METHODS: We used the methodology of case vignettes with the participation of 142 rheumatologists. Three baseline clinical vignettes were presented: (1) the physician was asked to indicate the most appropriate period to schedule the next visit over 5 years, (2) the physician was tested about parameters for follow-up (including traps), and (3) various results (both clinical, biological, densitometric, and radiological) were given by random and analyzed as determinants of treatment changes. RESULTS: The study allowed assessment of 426 virtual clinical cases. Clinical examinations, patient's height, inquiries about falls, and adherence to treatment were deemed necessary in > 90% of cases. Bone mineral density was measured in 22, 40, and 71% of cases at 2, 3, and 5 years, respectively. Dental follow-up was recommended in less than 25% of cases. Only 4.2% of patients were maintained on the same treatment at 5 years, and a change of treatment (stop or switch) occurs in 20-30% of cases at each visit. Significant determinants were adherence to treatment, serum C-terminal crosslinking telopeptide of type 1 collagen (CTX) value, change in patient's height, and the occurrence of an incident vertebral fracture. CONCLUSION: Our study shows that maintenance of oral bisphosphonate in postmenopausal women managed by rheumatologists is low; there are few determinants of these changes and more information on appropriate follow-up could help in patients' management.
Authors: Douglas C Bauer; Ann Schwartz; Lisa Palermo; Jane Cauley; Marc Hochberg; Art Santora; Steven R Cummings; Dennis M Black Journal: JAMA Intern Med Date: 2014-07 Impact factor: 21.873
Authors: Ethel S Siris; Steven T Harris; Clifford J Rosen; Charles E Barr; James N Arvesen; Thomas A Abbott; Stuart Silverman Journal: Mayo Clin Proc Date: 2006-08 Impact factor: 7.616
Authors: Edward Franek; Marek Tałałaj; Hanna Wichrowska; Beata Czerwienska; Rafał Filip; Krzysztof Safranow; Ewa Marcinowska-Suchowierska; Andrzej Wiecek Journal: Aging Clin Exp Res Date: 2008-12 Impact factor: 3.636
Authors: John W Peabody; Jeff Luck; Peter Glassman; Sharad Jain; Joyce Hansen; Maureen Spell; Martin Lee Journal: Ann Intern Med Date: 2004-11-16 Impact factor: 25.391