Leslie Carlin

Fracture risk assessment after BMD examination: whose job is it, anyway?

SummaryFracture risk assessments on bone mineral density reports guide family physicians’ treatment decisions but are subject to inaccuracy. Qualitative analysis of interviews with 22 family physicians illustrates their pervasive questioning of reported assessment accuracy and independent assumption of responsibility for assessment. Assumption of responsibility is common despite duplicating specialists’ work.IntroductionFracture risk is the basis for recommendations of treatment for osteoporosis, but assessments on bone mineral density (BMD) reports are subject to known inaccuracies. This creates a complex situation for referring physicians, who must rely on assessments to inform treatment decisions. This study was designed to broadly understand physicians’ current experiences with and preferences for BMD reporting; the present analysis focuses on their interpretation and use of the fracture risk assessments on reports, specificallyMethodsA qualitative, thematic analysis of one-on-one interviews with 22 family physicians in Ontario, Canada was performed.ResultsThe first major theme identified in interview data reflects questioning by family physicians of reported fracture risk assessments’ accuracy. Several major subthemes related to this included questioning of: 1) accuracy in raw bone mineral density measures (e.g., g/cm2); 2) accurate inclusion of modifying risk factors; and 3) the fracture risk assessment methodology employed. A second major theme identified was family physicians’ independent assumption of responsibility for risk assessment and its interpretation. Many participants reported that they computed risk assessments in their practice to ensure accuracy, even when provided with assessments on reports.ConclusionsResults indicate family physicians question accuracy of risk assessments on BMD reports and often assume responsibility both for revising and relating assessments to treatment recommendations. This assumption of responsibility is common despite the fact that it may duplicate the efforts of reading physicians. Better capture of risk information on BMD referrals, quality control standards for images and standardization of risk reporting may help attenuate some inefficiency.

Information to fight the flab: findings from the Net.Weight Study

The purpose of the paper is to examine information use and information literacy in the context of weight management. It reports on a two-year study funded by the Department of Health known informally as the Net.Weight Study. Net.Weight examined the potential for increased, innovative and effective uses of information and communication technologies (ICTs) to support the self management of weight. The research was conducted in the city of Brighton & Hove by an inter-disciplinary team from the University of Brighton. The paper gives a brief overview of the various methods used in the study as a whole but discusses one strand, the user survey, in more detail. The survey gathered data on people’s information and ICT use around weight management. The design of the survey questionnaire required the adaptation of existing literacy assessment instruments and this process is described in this paper. The findings show that people use a wide range of information sources for information and support around weight management. The most useful sources are slimming groups, food packaging, friends and family, magazines, TV and health books, thus representing a variety of media, formal and informal, and including human sources. The internet was reported to be a useful source for around half the survey respondents and is most often used for information about diet and exercise. A majority of respondents described themselves as active information seekers and confident about their information skills. They are less confident about internet information than information generally and even less confident about using the internet to support weight management activities. The concept of literacies, particularly around information and health, provide a framework for examining the Net.Weight findings. The findings are discussed in terms of their implications for health information policy and for those interested in applying information literacy theory to health. The role of healthcare practitioners in weight management information is addressed, as is the need for targeted rather than generic health information. It is suggested that the work done in the education sector to increase awareness of information literacy and improve skills could provide a useful model of good practice in a health context. However, the evidence provided by the Net.Weight study suggests that for such an approach to be relevant it needs to reflect the complexity of health information processes in everyday lives.

Working (IT) out together: engaging the community in e-health developments for obesity management

In this chapter, we combine sociological research on the ‘e-society’ and the ‘new public health’, to offer a critique of ‘e-health discourse’. Central to this discourse is the association of greater availability of information and information and communication technologies (ICTs) with notions of patient empowerment and the ability to engage more actively in self care. Drawing on an action-oriented research project exploring and intervening in the lived experience of those seeking to manage their weight, we employ a Foucauldian notion of discourse and of knowledge/power to reflect upon the sociotechnical configurations that constitute self care in the context of obesity management.

Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study

Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontarios family physicians (FPs). Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing. Results. We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described. Conclusions. These findings lend support to what has been documented at the population level suggesting a tendency among FPs to refer menopausal women (at low risk). Emphasis on referral of high-risk groups as well as men and further clarification and education on the appropriate intervals for follow-up testing is warranted.

To see or not to see: a qualitative interview study of patients' views on their own diagnostic images

Objectives To ascertain what meaning individuals attach to perceiving images of their own interior body and how the images and their meanings affect the clinical consultation. Design Face-to-face semistructured interviews. Participants 25 adult patients in southern England who, within the preceding 12 months, had been referred for diagnostic imaging. Setting Community. Results For patients, being shown their own X-rays, MRIs or CT images creates a variety of effects: (1) a sense of better understanding of the diagnosis; (2) validation of their sensory and emotional response to the illness or injury and (3) an alteration to the tenor and nature of the clinical encounter between patient and physician. In addition to meanings attached to these images, patients also impute meaning to the physicians decision not to share an image with them. The desire to see their image was greater in those patients with a skeletal injury; patients are less keen on viewing abdominal or other soft tissue images. Conclusions Viewing images of ones interior, invisible body is powerful and resonant in a number of ways. The experience of not seeing, whether through the patients or the physicians choice, is also fraught with meaning.

Double vision: An exploration of radiologists’ and general practitioners’ views on using picture archiving and communication systems (PACS)

This article explores the perspectives of two user groups, general practitioners (GPs) and consultant radiologists (CRs), on the rollout of picture archiving and communications systems (PACS) within acute trusts and eventually to primary care as part of the electronic patient record. Qualitative interviews were conducted with 16 CRs and 31 GPs. Analysis was carried out using a grounded theory approach. Radiologists expressed positive views about the implementation of PACS in secondary care, but were wary of GPs accessing radiological images. GPs expressed concerns about the added burdens that PACS might bring to primary care, but most felt that sharing images with patients could benefit doctor—patient communication and increase patient satisfaction. This study highlights both impediments and pathways to the implementation of PACS in primary care, and illustrates the importance of regarding PACS as socially embedded and users as culturally disparate.

In the Balance: Report of a Research Study Exploring Information for Weight Management

Abstract This paper uses findings from a research study called Net.Weight to examine the concepts of interaction, information quality and Internet-based information from the perspective of people engaged in managing their weight. The Net.Weight study was a two-year project funded by the British governments Department of Health and located in the city of Brighton and Hove. It examined the potential for increased, innovative and effective uses of information and communication technologies (ICTs) to support the self management of weight. The study had several inter-related research strands and the findings discussed in the paper emerged primarily from participatory learning workshops and evaluative interviews. The paper demonstrates that the interaction between people is an important aspect of the information process, which is often neglected in the literature. It suggests that exploring the user-user dimension might add to the understanding of information effectiveness. It also suggests that an approach to information and health literacy which includes a social as well as an individual perspective is necessary. On quality assessment, it supports findings from other studies that organisational authority is a key measure of reliability for lay users and that quality assessment tools have a limited role in the assessment process. The Net.Weight participants embraced the Internet as a medium for weight management information only when it added value to their existing information and weight management practices and when it could be integrated into their everyday lives.