Autonomy begets adherence: decisions to start and persist with osteoporosis treatment after group medical consultation
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ORIGINAL ARTICLE
Autonomy begets adherence: decisions to start and persist with osteoporosis treatment after group medical consultation Madeline S. Wilton-Clark 1 & A. Lynn Feasel 2,3 & Gregory A. Kline 2,3,4 & Emma O. Billington 2,3,4 Received: 16 July 2020 / Accepted: 17 August 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary Many individuals prescribed osteoporosis pharmacotherapy either do not start or do not persist with treatment. In this study, women who attended a group medical visit at an osteoporosis center which involved fracture risk assessment and focused on autonomous decision-making made treatment decisions with high confidence. Those who started pharmacotherapy were highly persistent. Purpose Adherence and persistence with osteoporosis pharmacotherapy is low, possibly reflecting lack of confidence in physicians’ treatment recommendations. We evaluated treatment decisions, decisional confidence, and 12-month treatment adherence among women who attended a group bone health consultation that fostered autonomous decision-making. Methods We prospectively assessed postmenopausal women referred to an osteoporosis clinic who chose to attend a group medical visit in lieu of one-on-one consultation. The group visit was facilitated by a specialist physician and nurse, involving estimation of 10-year major osteoporotic fracture risk (using FRAX®) and extensive education regarding fracture consequences and potential advantages and disadvantages of pharmacotherapy. No direct advice was given by the specialist. Post-consult, participants made an autonomous decision regarding treatment intent and followed up with their family physician to enact their chosen plan. Intentions to initiate pharmacotherapy were assessed immediately post-consult. Treatment status and decisional confidence were evaluated 3 and 12 months later. Three-month treatment status was considered to reflect final treatment decision. Persistence was defined as proportion of participants on treatment at 3 months who remained treated at 12 months. Results One hundred one women (mean (SD) age, 62.7 years (5.8); median (IQR) FRAX®, 10.7% (8.3–17.6)) participated. Immediately post-consult, 27 (26.7%) intended to initiate treatment. At 3 months, 23 (22.8%) were treated, and at 12 months, 21 (91.3%) remained persistent. Of 89 questionnaire respondents at 12 months, 85 (95.5%) reported confidence in their treatment decision. Conclusion When postmenopausal women are provided with individualized fracture risk estimates and enabled to make autonomous decisions regarding pharmacotherapy, ultimate decisions to receive treatment are made with confidence and result in high persistence at 12 months. Keywords Osteoporosis . Fracture prevention . Fracture risk assessment . Shared decision-making . Patient education
Introduction * Emma O. Billington [email protected] 1
Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2
Dr. Dav
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