Ioannidis George, Thabane Lehana, Gafni Amiram, Hodsman Anthony, Kvern Brent, Johnstone Dan, Plumley Nathalie, Salach Lena, Jiwa Famida, Adachi Jonathan D, Papaioannou Alexandra
Department of medicine, McMaster University, Hamilton, Ontario, Canada.
BMC Musculoskelet Disord. 2008 Oct 1;9:130. doi: 10.1186/1471-2474-9-130.
While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines.
The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.
After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7).
Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.
虽然《2002年加拿大骨质疏松症指南》提供了基于证据的预防、诊断和管理该病症的策略，但指南的发布和分发本身并未被证明能改变医生的临床方法。我们假设参与质量改进小组项目的初级保健医生会根据指南，在骨质疏松症风险因素认知和骨密度检测方面改变其对骨质疏松症患者的管理方式。
该项目包括五个质量改进小组阶段，分别为：1）培训与基线数据收集；2）首次教育干预与首次随访数据收集；3）首次策略实施会议；4）最终教育干预与最终随访数据收集；5）最终策略实施会议。共有340名小组成员组成34个质量改进小组并参与了该研究。采用广义估计方程法对教育干预前后（研究的第一年）医生对骨质疏松症风险因素的认知以及骨密度检测的合理利用情况进行建模。计算优势比（OR）和95%置信区间（95%CI）。
在研究的第1年之后，医生对其患者风险因素状况的确定程度有所提高。确定程度从既往椎体骨折状况的OR为1.4（95%CI：1.1，1.8）到既往髋部骨折状况的OR为6.3（95%CI：2.3，17.9）不等。此外，与低风险患者相比，高风险患者的骨密度检测有所增加（OR：1.4；95%CI：1.2，1.7）。
质量改进小组方法成功地提高了医生对骨质疏松症风险因素的认知，并根据《2002年加拿大骨质疏松症指南》实现了合理的骨密度检测。
