Kimber Cheryl M, Grimmer-Somers Karen A
Surgical and Speciality Services Division, Flinders Medical Centre, Adelaide, SA 5042, Australia.
Aust Health Rev. 2009 Aug;33(3):423-33. doi: 10.1071/ah090423.
Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure.
To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team's approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis.
This paper describes the implementation of multifaceted strategies to improve health-promoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies.
There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care.
This study highlights that appropriate and targeted intervention strategies can be effective if modelled on best practice guideline implementation approaches with the use of a coordinated post-fracture management approach to osteoporosis.
在澳大利亚，骨质疏松症是导致骨折、随后的残疾和过早死亡的重要原因。更好地检测和管理骨质疏松症将减少不必要的医疗支出。
在一家大型三级城市医院评估骨科医疗团队实施骨质疏松症指南的方法，以改善骨质疏松症的早期识别和管理。
本文描述了在一家城市医院的骨科门诊实施多方面策略以促进健康行为并提高工作人员对骨质疏松症指南的采纳情况，这反映了将指南建议纳入常规实践的组织和个人承诺。实施策略针对不同利益相关者群体的需求和观点。比较了五个审计数据集：两次基线审计中的62份患者记录，以及在接下来的3个月期间（2006年8月至2007年4月）收集的三次实施后审计中的31份患者记录。所有审计都使用相同的标准来评估对临床指南的遵守情况以及实施策略的结果。
在审计期间，对骨质疏松症指南的遵守情况持续改善。比较基线数据和实施后立即的数据，在被确定为骨质疏松性骨折的可能脆性骨折患者百分比方面有显著改善（P < 0.05）。在所有实施后审计期间，工作人员就其问题及如何处理与可能发生脆性骨折的患者进行沟通的百分比持续增加。对于患有已确诊骨质疏松症并出现脆性骨折的患者，在审计期间接受基于指南护理的患者百分比持续改善。
本研究强调，如果以最佳实践指南实施方法为模型，采用协调的骨折后骨质疏松症管理方法，适当且有针对性的干预策略可能会有效。
