Department of Medicine, McMaster University, Hamilton, Canada.
BMC Med Educ. 2009 Aug 6;9:54. doi: 10.1186/1472-6920-9-54.
Osteoporosis is a serious but treatable condition. However, appropriate therapy utilization of the disease remains suboptimal. Thus, the objective of the study was to change physicians' therapy administration behavior in accordance with the Osteoporosis Canada 2002 guidelines.
The Project was a two year cohort study that consisted of five Quality Circle (QC) 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 family physicians formed 34 QCs and participated in the study. Physicians evaluated a total of 8376, 7354 and 3673 randomly selected patient charts at baseline, follow-up #1 and the final follow-up, respectively. Patients were divided into three groups; the high-risk, low-risk, and low-risk without fracture groups. The generalized estimating equations technique was utilized to model the change over time of whether physicians
The odds of appropriate therapy was 1.29 (95% CI: 1.13, 1.46), and 1.41 (95% CI: 1.20, 1.66) in the high risk group, 1.15 (95% CI: 0.97, 1.36), and 1.16 (95% CI: 0.93, 1.44) in the low risk group, and 1.20 (95% CI: 1.01, 1.43), and 1.23 (95% CI: 0.97, 1.55) in the low risk group without fractures at follow-up #1 and the final follow-up, respectively.
QCs methodology was successful in increasing physicians' appropriate use of osteoporosis medications in accordance with Osteoporosis Canada guidelines.
骨质疏松症是一种严重但可治疗的疾病。然而,这种疾病的适当治疗方法仍然不尽如人意。因此,本研究的目的是根据加拿大骨质疏松症 2002 年指南改变医生的治疗管理行为。
该项目是一项为期两年的队列研究,包括五个质量圈 (QC) 阶段,包括:1) 培训和基线数据收集,2) 第一次教育干预和第一次随访数据收集,3) 第一次策略实施会议,4) 最终教育干预和最终随访数据收集,以及 5) 最终策略实施会议。共有 340 名家庭医生组成 34 个 QC 并参与了这项研究。医生总共评估了 8376 名、7354 名和 3673 名随机选择的患者的图表,分别在基线、随访 1 和最终随访时。患者分为三组:高危组、低危组和低危无骨折组。利用广义估计方程技术对医生随着时间的推移改变适当治疗的可能性进行建模。
高危组在随访 1 和最终随访时,适当治疗的几率分别为 1.29(95%CI:1.13,1.46)和 1.41(95%CI:1.20,1.66),低危组分别为 1.15(95%CI:0.97,1.36)和 1.16(95%CI:0.93,1.44),低危无骨折组分别为 1.20(95%CI:1.01,1.43)和 1.23(95%CI:0.97,1.55)。
QC 方法成功地增加了医生根据加拿大骨质疏松症指南使用骨质疏松症药物的适当性。