Can a web-based osteoporosis lecture increase physician knowledge and improve patient care? Karen E. Hansen, MD Assistant Professor of Medicine University of Wisconsin

Background Osteoporosis is highly prevalent Even following hospitalization for fragility fracture, many patients remain untreated Effective osteoporosis therapies are available, decreasing fracture rates by ~50%

Study Hypotheses An on-line lecture will increase physician knowledge about osteoporosis An on-line lecture about osteoporosis can improve patient care

Study Preparation Slide lecture developed Voice portion recorded and loaded onto web Pre-test and post-test developed with assistance from Craig Gjerde, Ph.D. Pre-test and post-test embedded in web based program Chart review form developed for assessment of change in patient care UW IRB Protocol and consent form developed, approved by HSC

Study Design- Phase 1 invitation sent to 30 IM Faculty Consent obtained by Elaine Rosenblatt Elaine provides internet link to web- based lecture Physicians can access lecture at any time and from any location Must complete pre-test and post-test Receive $50 for participation

Study Design- Phase 2 From the clinics of consenting doctors, Elaine identifies five new postmenopausal women at least 60 years of age Initial clinic note printed, identifiers removed Chart review form used to identify physician recorded history, exam, and treatment plan pertaining to osteoporosis

Study Design- Phase 3 Each patient note reviewed twice to determine patient care scores Discrepancies resolved by 3 rd review Data entered in duplicate into Excel Data charted to determine whether parametric or non-parametric Wilcoxon rank sum test used in statistical analyses

Chart Review Form HistoryExaminationTherapy Age Prior fracture Prior BMD Prior OP therapy Calcium intake Vitamin D intake Exercise habits Alcohol use Tobacco use Family hx OP and fracture Use of oral steroids Height Weight Kyphosis Finger breadths between lower ribs & upper pelvis Abdominal distention DXA ordered if no prior and age>65 years or <65 years and additional fracture risk factor Therapy started for woman with prior low trauma fracture or osteoporosis by DXA Discussed calcium Discussed vitamin D

Physician Knowledge Significantly Improves p=0.03, Wilcoxon rank sum test

Patient Care Scores Remain the Same ItemPre-test ScorePost-test Score History Examination Plan Composite

Study Strengths & Weaknesses Small sample size –Patient and Physician Performance setting –New patient visit –Physician unaware that visit would be “judged” in a study –Patient unaware that visit would be assessed by external reviewer wrt osteoporosis Selection bias –Physician participants may have different knowledge or interest in OP than those who did not participate

Conclusions In this small study, an on-line osteoporosis lecture did increase physician knowledge However, no change in patient care was noted Further research studies are needed to determine optimal teaching methods that favorably influence patient care

A Sincere “Thank You” to: Elaine Rosenblatt Physician participants Internal Medicine Section, R&D Committee George Mejicano Craig Gjerde CME Office UW Human Subjects Committee Matt Crowe