Background/Purpose: Unexplained interruptions in treatment are common among patients with osteoporosis, but it is not well studied how PCP turnover affects incompletion of osteoporosis treatment for the high risk SDH patient population in a CHC setting. We sought to evaluate if provider change, in addition to epidemiologic features and clinical comorbidity, increases risk for the treatment incompletion.

Methods: We defined PCP turnover as a patient having a PCP who has worked at the clinic < 5 years, and treatment incompletion as no treatment or being treated < 3 years with no clear reason for the discontinuation and used Charlson Comorbidity Index (CCI) to assess clinical comorbidity. We used electronic health record (EHR) data from a CHC primary care clinic and identified patients with a diagnosis of osteoporosis who have seen for the last 42 months at the clinic and still alive. The patients who have since established care in another clinic or haven't had a visit for more than 2 years are excluded. The study included 381 patients with 232 identifying as Asian (60.9%), 60 White (15.7%), 59 Black (15.5%), 15 Hispanic (3.9%), 13 Pacific Islanders (3.4%), and other race/ethnicity (0.5%). Average age was 79.9. The study population by sex, preferred language, PCP turnover rate, and CCI score are men(30, 7.9%) vs women(351, 92.1%), Vietnamese(215, 56.4%) vs English(95, 24.9%) vs Spanish(45, 11.8%) vs Cape Verdean Creole(13, 3.4%) vs other language (13, 3.4%), no PCP turnover(228, 59.8%) vs PCP turnover(153, 40.1%), CCI score 1-2(56, 14.7%) vs CCI score 3-4(164, 43%) vs CCI score ≥5 (161, 42.2%).

Results: 25 patients (6.5%) did not complete their osteoporosis treatment. The characteristics of the 25 patients consist of Asian (12, 48%), Black (9, 36%), White (2, 8%), Hispanic (2, 8%) with preferred language of Vietnamese (12, 48%), English (8, 32%), Spanish (3,12%), and Cape Verdean Creole (2, 8%). For PCP turnover, 13 out of 25(52%) patients have not experienced PCP turnover, and 12 patients (48%) have experienced. This cohort’s CCI scores are 1-2(3, 20%) vs 3-4(11, 73%) vs ≥ 5(11, 73%). Compared to the patient population at the CHC with osteoporosis diagnoses, relative risk(RR)s for incomplete treatment are ①PCP turnover(RR 1.29, P=0.2) vs no turnover(RR 0.9, P=0.7); ② ethnicity, White (RR 0.54, P=0.3) vs Asian (RR 0.86, P=0.5) vs Black (RR 2.0, P=0.02) vs Hispanic (RR 2.0, P=0.4); ③ language, Vietnamese (RR 0.9, P=0.7) vs Spanish(RR 0.7,P=0.6), vs English (RR 1.2, P=0.5) vs Cape Verdean creole (RR 2.2, P=0.3); ④ CCI score, 1-2(RR 0.84, P=0.7),vs 3-4(RR 1.0, P=1.0)) vs ≥5 (RR 1.0 P=0.9).

Conclusion: Among CHC population of patients with diagnoses with osteoporosis and SDH-related needs, we looked at how PCP turnover, epidemiologic factors and clinical complexity affect treatment incompletion. Patients who experienced PCP turnover are 29% less likely to complete their treatment (RR 1.29). Black and Hispanic population and Cape Verdean Creole speaking patients are at almost doubled risk for treatment incompletion (RR ~2.0). In this study, CCI did not significantly affect Osteoporosis treatment incompletion(R~1.0). These findings highlight the impact of PCP turnover and ethnic difference/language barrier on the incompletion of osteoporosis treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/for-vulnerable-population-treated-at-a-community-health-center-chc-primary-care-physician-pcp-turnover-should-be-included-in-social-determinants-of-health-sdh-on-non-completing-osteoporosis-tre/