Oral Presentation 29th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2019

Osteoporosis in premature ovarian insufficiency: Clinicians’ knowledge gaps and barriers to care. (#18)

Alicia R Jones 1 2 , Helena Teede 1 2 , Peter Ebeling 1 3 , Robyn Langham 4 , Fran Milat 1 3 , Amanda Vincent 1 2
  1. Department of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
  2. Monash Centre for Health Research and Implementation (MCHRI), Monash University, Clayton, Victoria, Australia
  3. Department of Medicine, Monash University, Clayton, Victoria, Australia
  4. School of Rural Health, Monash University, Clayton, Victoria, Australia

 

Introduction: Premature ovarian insufficiency (POI), spontaneous or iatrogenic menopause before age 40, affects 1% of women(1). POI is associated with reduced bone density; however, POI bone health management appears sub-optimal(2-4). Geographic discrepancy in postmenopausal osteoporosis care is evident with higher hip fracture and lower treatment rates in Australian rural versus metropolitan areas(5, 6). This study aimed to assess Primary Care Physicians’ (PCPs) POI osteoporosis knowledge gaps and needs and investigate geographic variation.

Methods: Online questionnaire, assessing demographics, POI osteoporosis knowledge, care barriers and educational needs, was distributed to PCPs registered with HealthEd (national medical education provider).  Data analysis included Chi-square, ANOVA and multivariable regression. Practice location was classified by remoteness into ((i) major city (capital), (ii) major city (regional), (iii) inner regional, and (iv) outer areas (outer regional, remote and very remote)(7).

Results:   Of 688/987 eligible PCP respondents, the mean age was 50.7 years, 78.8% were female and 98.3% managed <10 POI patients per week. Most (62.0%) practised in a major city (capital), 12.8% in a major city (regional), 18.9% in inner regional and 6.30% in outer areas. 558 (81.0%) of PCPs identified a “need to know more” about POI osteoporosis. Mean osteoporosis knowledge score was 9.18 /14 (range 3-13), with greater knowledge in outer areas compared to major city (capital) (9.62 vs 9.16, 95% CI for difference 0.002-1.00; p=0.049 adjusting for age, gender and training status). 41% of PCPs reported barriers to POI osteoporosis care which varied according to geographical area (Table 1). Conference or Osteoporosis Australia web-resources were the preferred education method.

Conclusion:  PCPs demonstrate POI osteoporosis knowledge gaps and barriers to care which differ according to practice area. These factors require consideration when designing care improvement programs.

 

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  2. Gibson-Helm M, Teede H, Vincent A. Symptoms, health behavior and understanding of menopause therapy in women with premature menopause. Climacteric. 2014;17(6):666-73.
  3. Rauh LA, Pannone AF, Cantrell LA. Hormone replacement therapy after treatment for cervical cancer: Are we adhering to standard of care? Gynecol Oncol. 2017;147(3):597-600.
  4. Mittal M, Savvas M, Narvekar N, Panay N, Hamoda H. A cross-sectional national questionnaire survey assessing the clinical attitudes of members of the British Menopause Society to the management of women with premature ovarian insufficiency. Post Reprod Health. 2014;20(3):90-7.
  5. Lai MMY, Ang WM, McGuiness M, Larke AB. Undertreatment of osteoporosis in regional Western Australia. Australas J Ageing. 2012;31(2):110-4.
  6. Australian Commission on Safety and Quality in Health Care and National Performance Authority. Australian Atlas of Healthcare Variation. Sydney; 2015.
  7. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, cat no. 1270.0.55.005 2016 [Available from: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.005Main+Features1July%202016?OpenDocument.