German primary care doctors' awareness of osteoporosis and knowledge of national guidelines

Abstract

Aims: With the aging of populations in industrialized countries, managing osteoporosis in the primary care setting becomes increasingly important. General practitioners (GPs) are in an ideal position to identify and manage patients who are at an increased risk of osteoporosis and fracture. In a cross-sectional survey we studied whether German GPs (1) are aware of osteoporosis as an urgent health problem, (2) felt competent to manage patients with osteoporosis, (3) knew and used the national guideline for osteoporosis treatment and if not, (4) which barriers prevented them from doing so.

Participants and methods: A representative random sample of German GPs were sent a 30-item standardized questionnaire by mail. Chi-square statistics and multiple logistic regression were used to detect associations between knowledge of guidelines and explanatory variables.

Results: Of 2,194 doctors addressed, 892 (41.1%) answered the questionnaire. The majority of doctors (82.7%) felt competent in osteoporosis management (95% confidence interval: 80.2 - 85.2) and only 11.2% (8.2 - 13.1) did not consider osteoporosis an important problem in their practice. About half (459/892) reported knowing the national osteoporosis guideline well (51.7%; 48.4 - 55.0), whereas 22.6% (19.9 - 25.4) admitted to not being familiar with it at all. Knowledge of the guideline was positively associated with being a female doctor (OR=1.36; 1.01-1.85), having Internet access (OR=1.40, 1.06 - 1.85), seeing institutionalized patients (OR=1.67; 1.03 -2.69), and caring for patients with osteoporosis at a higher frequency (OR=2.60; 1.93 - 3.50). Nearly 43% (39.7 - 46.2) used the guideline in their practice without problems. In free-text fields, GPs reported most frequently that budgetary restrictions preventing the prescription of appropriate medication represented a severe problem for osteoporosis management.

Conclusion: Although most GPs are aware of osteoporosis as an important health problem and felt competent in the management of this disease, only half of the respondents knew and used the national guideline. This may explain deficits in diagnosis and therapy of osteoporosis in Germany. Since guideline knowledge and frequency of consultations for osteoporosis strongly correlate, proper dissemination of the guideline may further enhance awareness of, and evidence-based treatment for, osteoporosis.