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The article describes the Fracture Intervention Trial (FIT) Long Term Extension (FLEX) Trial which investigated the use of alendronate for fracture treatment in post-menopausal women. The trial revealed that ten years of alendronate treatment did not significantly decrease the risk of nonvertebral fractures as compared to five years of alendronate treatment. Continuing treatment with alendronate reduced the risk of clinical vertebral fractures but not morphometric vertebral fractures.

Weight loss is an important therapeutic strategy in overweight persons with diabetes (DM). However, there are limited data available from real world environments describing weight change patterns early in the course of diabetes. Using electronic medical records of Kaiser Permanente Northwest, we identified patients aged 21-75 with newly diagnosed DM from 1/1/1997-12/31/2004 who had a baseline weight and at least 3 weights in the 12 months after diagnosis, excluding patients with a severe illness or condition associated with unintentional weight change (n=4135). We stratified patients into one of four therapeutic regimens used in the first year after diagnosis: metformin alone, sulphonylurea (SU) alone, metformin and SU, or neither. Medication use was defined as having received > 30 days of the medication during the first year. Insulin and thiazolidinediones were not included because of the small number of users after newly diagnosed DM. We then estimated weight trajectories and identified associated factors using growth curve analyses with HLM 6.0. The cohort was 52% female, mean age 56.0 (sd 10.2) years, mean baseline weight 222 (51) pounds, and mean BMI 35.3 (7.5) kg/m². In the first 12 months following diagnosis, 50% received no DM medication, 13% metformin only, 28% SU only, and 9% metformin plus SU. Patients receiving SU alone or in combination experienced a small weight gain (Figure). Those taking metformin alone and those receiving no drug lost weight during the first 6 months, but then began regaining weight. Initial therapy is an important consideration when weight loss is a therapeutic goal. Patients who successfully initially lose weight initially appear to need additional support to maintain and accelerate weight loss. The first 4-6 months after DM diagnosis may be critical for selecting and applying the optimal intensity of weight loss treatments. [ABSTRACT FROM AUTHOR]

Objectives: Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening., Study Design: Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization., Methods: A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening., Primary Outcome Measure: receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression., Results: Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening., Conclusions: More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.

Objectives: To compare completion rates of colorectal cancer screening tests within a health maintenance organization before and after widespread adoption of the fecal immunochemical test (FIT)., Study Design: Retrospective cohort study., Methods: Using electronic medical records of 113,901 patients eligible for colorectal cancer screening, we examined test completion during 2 successive time periods among those who received an automated screening outreach call. The time periods were: 1) the "guaiac fecal occult blood test (gFOBT) era," a 15-month period during which only gFOBT was routinely offered, and 2) a 9-month "FIT era," when only a new FIT was routinely offered. In addition to analyzing completion rates, we analyzed the impact of practice-level variables and patient-level variables on overall screening completion during the 2 different observation periods., Results: The change from gFOBT to FIT in an integrated care delivery system increased the likelihood of screening completion by 7.7% overall, and the likelihood of screening with a fecal test by 8.9%. The greatest gains in screening completion using FIT were among women and elderly patients. Completion of FIT was not as strongly associated with medical office visits or with having a primary care provider as was screening with gFOBT., Conclusions: Adoption of FIT within an integrated care system increased completion of colon cancer screening tests within a 9-month assessment period, compared with a previous 15-month gFOBT era. Higher completion rates of the FIT may allow for more effective dissemination of programs to increase colorectal cancer screening through centralized outreach programs.

Objective: To evaluate the effect of a patient panel-support tool (PST) on care delivery for diabetes mellitus (DM) and cardiovascular disease (CVD)., Study Design: Retrospective longitudinal cohort study among primary care providers (PCPs), with 2005 as the preintervention, 2006 as the implementation, and 2007 as the postintervention period., Methods: We estimated the intervention effect using electronic medical record data and hierarchical linear models. The intervention was a PST displaying "care gaps" and recommendations for glycosylated hemoglobin, low-density lipoprotein cholesterol, and blood pressure screening and control; retinopathy, nephropathy, and foot screening; aspirin, statin, and angiotensin-converting enzyme inhibitor or beta-blocker use; and influenza and pneumococcal vaccination. Participants were qualifying PCPs and health maintenance organizations; patients. Patients had DM or CVD and 12 months of membership (n = 30,273 DM; 26,414 CVD). Main measures were mean percentages of care recommendations that were met by PCPs per patient per month (the care score)., Results: From 2005 to 2007, the mean care score (95% confidence interval) increased for both DM and CVD, from 63.5 (62.7, 64.3) to 70.6 (69.8, 71.4) and from 67.9 (67.2, 68.7) to 72.6 (71.9, 73.3), respectively. After adjustments, DM and CVD patients had improvements in the care score of 7.6 and 5.1, respectively, in 2007 compared with 2005 (P < .001)., Conclusions: Delivery of care recommendations for DM and CVD improved after implementation of a PST. More research is necessary to optimize results and determine whether patient outcomes improve.

Objective: To test the efficiency and cost-effectiveness of interventions aimed at enhancing laboratory monitoring of medication., Study Design: Cost-effectiveness analysis., Methods: Patients of a not-for-profit, group-model HMO were randomized to 1 of 4 interventions: an electronic medical record reminder to the clinician, an automated voice message to patients, pharmacy-led outreach, or usual care. Patients were followed for 25 days to determine completion of all recommended baseline laboratory monitoring tests. We measured the rate of laboratory test completion and the cost-effectiveness of each intervention. Direct medical care costs to the HMO (repeated testing, extra visits, and intervention costs) were determined using trial data and a mix of other data sources., Results: The average cost of patient contact was $5.45 in the pharmacy-led intervention, $7.00 in the electronic reminder intervention, and $4.64 in the automated voice message reminder intervention. The electronic medical record intervention was more costly and less effective than other methods. The automated voice message intervention had an incremental cost-effectiveness ratio (ICER) of $47 per additional completed case, and the pharmacy intervention had an ICER of $64 per additional completed case., Conclusions: Using the data available to compare strategies to enhance baseline monitoring, direct clinician messaging was not an efficient use of resources. Depending on a decision maker's willingness to pay, automated voice messaging and pharmacy-led efforts can be efficient choices to prompt therapeutic baseline monitoring, but direct clinician messaging is probably a less efficient use of resources.