Abstract
Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.
Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.
Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).
Results
DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).
Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.
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References
WHO (2007) Prevention and management of osteoporosis: report of a WHO scientific group. In. World Health Organisation Scientific Group on the prevention and management of osteoporosis
Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int 17:1404–1409
Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002) Preventing osteoporosis: outcomes of the Australian fracture prevention summit. Med J Aust 176:S1–S16
Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA (2005) The human cost of fracture. Osteoporos Int 16:2046–2052
Cadarette SM, Gignac MAM, Jaglal SB, Beaton DE, Hawker GA (2007) Access to osteoporosis treatment is critically linked to access to dual-energy x-ray absorptiometry testing. Med Care 45:896–901
Sanders K, Nicholson GC, Ugoni AM, Pasco JA, Seeman E, Kotowicz MA (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the geelong osteoporosis study. Med J Aust 170:467–470
Pasco JA, Brennan SL, Henry MJ, Nicholson GC, Sanders KM, Zhang Y, Kotowicz MA (2011) Changes in hip fracture rates in south-eastern Australia spanning the period 1994–2007. J Bone Miner Res 26:1648–1654
Sanders K, Seeman E, Ugoni AM, Pasco JA, Martin TJ, Skoric B, Nicholson GC, Kotowicz MA (1999) Age- and gender-specific rate of fractures in Australia: a population-based study. Osteoporos Int 10:240–247
Gass M, Dawson-Hughes B (2006) Preventing osteoporosis-related fractures: an overview. Am J Med 119:3S–11S
WHO (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organisation, Geneva
(2006) Medicare Services Advisory Committee: An application for increasing the availability for bone mineral densitometry (BMD) testing to at-risk groups by Osteoporosis Australia. In. Osteoporosis Australia, p 45
Brown MA, Bradlow J, Gray AM (2001) Cost effectiveness of bone density measurements. J Brit Meno Soc 7:130–135
Khosla SM, Melton LJ III, Riggs BL (1999) Osteoporosis: gender differences and similarities. Lupus 5:393–396
Henry MJ, Pasco JA, Nicholson GC, Kotowicz MA (2011) Prevalence of osteoporosis in Australian men and women. Med J Aust 195:321–322
Ebeling PR (2008) Clinical practice. Osteoporosis in men. New Engl Med J 358:1474–1482
Orwoll E (1999) Osteoporosis in men. New Dimens Osteoporos 1:2–8
Ebeling PR (1998) Osteoporosis in men. New insights into aetiology, pathogenesis, prevention and management. Drugs Aging 6:421–434
Otmar R, Henry MJ, Kotowicz MA, Nicholson GC, Korn S, Pasco JA (2011) Patterns of treatment in Australian men following fracture. Osteoporos Int 22:249–254
ABS (2009) Population by age and sex, regions of Australia, 2009, 3235.0. Australian Bureau of Statistics, Canberra
Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM (2006) Evaluating the overall impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Ed Res 21:688–694
Glasgow RE, Garth McKay H, Piette JD, Reynolds KD (2001) The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Ed Couns 44:119–127
Jilcott S, Ammerman A, Sommers J, Glasgow RE (2007) Applying the RE-AIM frameword to assess the public health impact of policy change. Ann Behav Med 34:105–114
Sallis JF, Cervero R, Ascher WW et al (2006) An ecological approach to creating active living communities. Ann Rev Public Health 27:297–322
Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:229–238
Cheng NGM (2008) Osteoporosis screening for men: are family physicians following the guidelines? Can Fam Physician 54:1140–1145
Seeman E, Bianchi G, Khosla S, Kanis JA, Orwoll E (2006) Bone fragility in men—where are we? Osteoporos Int 17:1577–1583
Otmar R, Reventlow SD, Nicholson GC, Kotowicz MA, Pasco JA (2012) General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management. Arch Osteoporos Online 17 July
Torpy AMJ, Brennan SL, Kotowicz MA, Pasco JA (2012) Reasons for referral to bone densitometry in men and women aged 20–40 years: population-based data. Arch Osteoporos 7:173–178
Neuner JM, Zhang X, Sparapani R, Laud PW, Nattinger AB (2007) Racial and socioeconomic disparities in bone density testing before and after hip fracture. J Gen Int Med 22:1239–1245
Acknowledgments
SL Brennan is supported by an Early Career Fellowship from the National Health and Medical Research Council (NHMRC) of Australia (1012472). This study was funded by an Early Career Research Grant from The University of Melbourne (601158) and a RM Gibson Scientific Research Award from the Australian Association of Gerontology. We thank Yvonne Birch for extracting these data and Alice Torpy for her assistance in data cleaning.
Conflicts of interest
SL Brennan, B Sarah, PR Ebeling, CJ Metge, AG Dobbins, and JA Pasco have no conflict of interest. MA Kotowicz is the Director of the Geelong Bone Density Service, Australia. WD Leslie is the Director of the Manitoba Bone Density Service, Canada and speaker Bureau of Amgen, Eli Lilly, Novartis with research Grants from Novartis, Amgen, Genzyme.
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Brennan, S.L., Kotowicz, M.A., Sarah, B. et al. Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia. Arch Osteoporos 8, 152 (2013). https://doi.org/10.1007/s11657-013-0152-1
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DOI: https://doi.org/10.1007/s11657-013-0152-1