Brent Kvern

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

See related commentary by Kanis, page [1829][1] Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures. [1][2],[2][3] The focus now is on preventing fragility fractures and their negative

The osteoporosis care gap in Canada

BackgroundThe presence of a fragility fracture is a major risk factor for osteoporosis, and should be an indicator for osteoporosis diagnosis and therapy. However, the extent to which patients who fracture are assessed and treated for osteoporosis is not clear.MethodsWe performed a review of the literature to identify the practice patterns in the diagnosis and treatment of osteoporosis in adults over the age of 40 who experience a fragility fracture in Canada. Searches were performed in MEDLINE (1966 to January 2, 2003) and CINAHL (1982 to February 1, 2003) databases.ResultsThere is evidence of a care gap between the occurrence of a fragility fracture and the diagnosis and treatment of osteoporosis in Canada. The proportion of individuals with a fragility fracture who received an osteoporosis diagnostic test or physician diagnosis ranged from 1.7% to 50%. Therapies such as hormone replacement therapy, bisphosphonates or calcitonin were being prescribed to 5.2% to 37.5% of patients. Calcium and vitamin D supplement intake was variable, and ranged between 2.8% to 61.6% of patients.ConclusionMany Canadians who experience fragility fracture are not receiving osteoporosis management for the prevention of future fractures.

Osteoporosis Canada 2010 Guidelines for the Assessment of Fracture Risk

Osteoporosis Canadas 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada focus on the clinical impact of fragility fractures, and on the assessment and management of women and men at high risk for fragility fracture. These guidelines now integrate a 10-year absolute fracture risk prediction into an overall management approach by using validated risk assessment tools. There currently is a large gap between optimal practices and those that are now being provided to Canadians with osteoporosis. These guidelines are part of a concerted effort to close this gap. Key changes from the 2002 guidelines of interest and relevance to radiologists are highlighted in this report.

Evaluation of a problem‐based learning workshop using pre‐ and post‐test objective structured clinical examinations and standardized patients

Background: Osteoporosis is a health care issue in which family physicians play a major role. Although awareness of osteoporosis is high, recent studies suggest that application of recent advances in its treatment to the clinical setting may be low. We have developed a problem‐based learning intervention for osteoporosis in which paired rheumatologists and family physicians developed nine problem‐solving clinical scenarios. An educational matrix was used to link specific case scenarios with individual teaching objectives, developed via a previous needs assessment. Family physicians participated in the workshop, developing best practice responses to the clinical scenarios with a trained facilitator and content expert. Methods: To assess the impact of this intervention, family physicians participated in a pre‐and post‐test evaluation, using objective structured clinical examinations and standardized patients. Objective structured clinical examination stations tested knowledge, skills, and judgment relating to osteoporosis with respect to risk factors, use of appropriate investigations including bone mineral densitometry (BMD), strategies for the prevention of osteoporosis (both pharmacologic and nonpharmacologic), treatment options for established osteoporosis (bisphosphonates and hormone replacement therapy), and management of recent osteoporosis fracture. Participants were evaluated using a predetermined score generated by their responses to objective structured clinical examinations and standardized patients (max. score = 101). Evaluations were conducted anonymously, although participants had access to their own pre‐and post‐test results for personal feedback. The impact of the workshop was assessed by comparing pre‐and post‐test responses by group, by individual, and by station. Results: Participants demonstrated a significant improvement in their post‐workshop scores. Of 40 participants, 26 showed improvement in score (>+10), 13 showed modest change (+1 to +10), and 1 showed a marked decrease (>−10). The greatest improvements were seen in the management of the male osteoporosis patient, determination of risk factors for osteoporosis, and the use and interpretation of bone mineral densitometry. Family physicians reported general satisfaction with the content and format of both the workshop and the evaluation process. Implications: We conclude that this type of problem‐based learning intervention workshop results in improved knowledge, skills, and judgment in the management of osteoporosis by family physicians as objectively assessed using a pre‐and post‐test format including objective structured clinical examinations and standardized patients.

Manitoba Diabetes Care Project: Examining Trends in Diabetes Therapy Prescribing Patterns in Manitoba

ABSTRACT OBJECTIVE To assess changes in the prescribing patterns of physicians treating patients with diabetes in Manitoba. METHODES Data from Manitobas Drug Programs Information Network and Manitobas Diabetes Database were used to track drug utilization and obtain a longitudinal perspective of diabetes care from 1996 to 2001. RESULTS Treatment with oral antihyperglycemic, antihypertensive and lipid-lowering agents increased significantly (17%, 27% and 137%, respectively). However, prescriptions for medications for all 3 therapeutic indications remained low. Specifically, 42% of patients with diabetes were not prescribed any antihyperglycemic medication (oral and/or insulin); and only 42.4% and 26.5% received antihyperten- sive agents or lipid-lowering agents, respectively. CONCLUSION Initiatives are needed to help physicians in Manitoba optimize their use of efficacious pharmacologic therapies in patients with diabetes.

Lessons learned in global family medicine education from a Besrour Centre capacity-building workshop

Abstract At a global level, institutions and governments with remarkably different cultures and contexts are rapidly developing family medicine centred health and training programmes. Institutions with established family medicine programmes are willing to lend expertise to these global partners but run the risk of imposing a postcolonial, directive approach when providing consultancy and educational assistance. Reflecting upon a series of capacity building workshops in family medicine developed by the Besrour Centre Faculty Development Working Group, this paper outlines approaches to the inevitable challenges that arise between healthcare professionals and educators of differing contexts when attempting to share experience and expertise. Lessons learned from the developers of these workshops are presented in the desire to help others offer truly collaborative, context-centred faculty development activities that help emerging programmes develop their own clinical and educational family medicine frameworks. Established partner relationships, adequate preparation and consultation, and adaptability and sensitivity to partner context appear to be particularly significant determinants for success.