Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Implement Sci. 2011 Jul 22;6:77. doi: 10.1186/1748-5908-6-77.
Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems. Although guidelines on assessing and managing osteoporosis are available, many patients are not receiving appropriate diagnostic testing or treatment. Findings from a systematic review of osteoporosis interventions, a series of mixed-methods studies, and advice from experts in osteoporosis and human-factors engineering were used collectively to develop a multicomponent tool (targeted to family physicians and patients at risk for osteoporosis) that may support clinical decision making in osteoporosis disease management at the point of care.
A three-phased approach will be used to evaluate the osteoporosis tool. In phase 1, the tool will be implemented in three family practices. It will involve ensuring optimal functioning of the tool while minimizing disruption to usual practice. In phase 2, the tool will be pilot tested in a quasi-experimental interrupted time series (ITS) design to determine if it can improve osteoporosis disease management at the point of care. Phase 3 will involve conducting a qualitative postintervention follow-up study to better understand participants' experiences and perceived utility of the tool and readiness to adopt the tool at the point of care.
The osteoporosis tool has the potential to make several contributions to the development and evaluation of complex, chronic disease interventions, such as the inclusion of an implementation strategy prior to conducting an evaluation study. Anticipated benefits of the tool may be to increase awareness for patients about osteoporosis and its associated risks and provide an opportunity to discuss a management plan with their physician, which may all facilitate patient self-management.
骨质疏松症在全球影响着超过 2 亿人，给医疗系统带来了沉重负担。尽管有评估和管理骨质疏松症的指南，但许多患者并未接受适当的诊断测试或治疗。通过对骨质疏松症干预措施的系统评价、一系列混合方法研究以及骨质疏松症和人为因素工程专家的建议进行综合分析，开发了一种多组件工具（针对家庭医生和有骨质疏松症风险的患者），可在护理点支持骨质疏松症疾病管理中的临床决策。
将采用三阶段方法来评估骨质疏松症工具。在第 1 阶段，该工具将在三个家庭实践中实施。这将涉及确保工具的最佳功能，同时将对常规实践的干扰降到最低。在第 2 阶段，将使用准实验性中断时间序列 (ITS) 设计对工具进行试点测试，以确定它是否可以改善护理点的骨质疏松症疾病管理。第 3 阶段将涉及进行定性干预后随访研究，以更好地了解参与者的体验以及对工具的感知实用性，以及在护理点采用工具的准备情况。
骨质疏松症工具有可能为复杂慢性疾病干预措施的开发和评估做出多项贡献，例如在进行评估研究之前纳入实施策略。该工具的预期益处可能是提高患者对骨质疏松症及其相关风险的认识，并为他们与医生讨论管理计划提供机会，这都可能有助于患者的自我管理。
