Background/Purpose: Osteopenia and osteoporosis are common yet underrecognized in the veteran population.
Methods: We tested basic bone health related knowledge among Veterans Affairs (VA) primary care providers (PCPs) before and after a 3 day intensive musculoskeletal mini-residency. Principles and practice of bone health were reviewed during 6 hours of small group sessions led by a practicing VA endocrinologist with expertise in osteoporosis. Topics included dietary calcium, vitamin D supplementation, and screening for osteoporosis. Self-reported satisfaction with the program was evaluated at the conclusion. An 8-item medical knowledge examination was administered at the beginning of the program (pre-test) and at the end (post-test). The post-test composite score was compared to the pre-test composite score for all participants.
Results: 17 full-time PCPs participated. 71% were female, with mean age 48.3 years (range 27-58), and mean number of years in practice 14.6 (range 1-23). 47% were physicians, 41% nurse practitioners, and 12% physician assistants. 79% practiced in community-based outpatient clinics and 29% at the associated tertiary care referral facility (Cleveland VA Medical Center).
|
Question |
% correct PRE |
% correct POST |
|
Screening age for osteoporosis in men in the absence of risk factors (70 years) |
25% |
94% |
|
Screening age for osteoporosis in women in the absence of risk factors (65 years) |
47% |
88% |
|
Content of calcium in one cup of milk (300mg) |
24% |
31% |
|
Recommended daily vitamin D intake for men over 70 years (1200mg) |
65% |
53% |
|
Serum 25 (OH) D3 level minimally sufficient for bone health (30 ng/ml) |
73% |
94% |
|
Identification of suitable candidates for FRAX screening algorithm |
59% |
71% |
|
Significant level for 10 year probability of major hip fracture per FRAX algorithm (3%) |
20% |
47% |
|
Significant level for 10 year probability of major osteoporotic fracture per FRAX algorithm (20%) |
14% |
35% |
FRAX www.shef.ac.uk/FRAX/tool.aspx
The program evaluation showed 100% very satisfied with the training experience and over 95% reporting the program as applicable to their clinical practice. 77% of participants improved their overall composite bone health knowledge score at the end of the program. Non-MDs had better baseline knowledge than MDs for recommended screening age for osteoporosis in women and recommended daily vitamin D intake. Areas of persistent knowledge deficit at the end of the residency included dietary calcium content and interpretation of the FRAX osteoporosis screening algorithm.
Conclusion: Participants demonstrated an increase in overall bone health knowledge after a mini-residency program. Not all areas improved. Further educational efforts should be directed to VA PCPs to further address methods to improve basic identification and treatment of osteopenia and osteoporosis. Particular emphasis should be directed to the use and interpretation of the FRAX screening algorithm.
Disclosure:
M. Pioro,
None;
N. Fisher,
None;
M. Grotzke,
None;
G. W. Cannon,
None;
M. Battistone,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-in-basic-bone-health-knowledge-among-va-primary-care-practitioners-during-a-focused-musculoskeletal-mini-residency/