在人群层面上缩小骨折后护理差距：一项随机对照试验。
Closing the gap in postfracture care at the population level: a randomized controlled trial.
机构信息
University of Manitoba, Winnipeg, Man.
出版信息
CMAJ. 2012 Feb 21;184(3):290-6. doi: 10.1503/cmaj.111158. Epub 2011 Dec 19.
BACKGROUND
Postfracture care is suboptimal, and strategies to address this major gap in care are necessary. We investigated whether notifications sent by mail to physicians and patients would lead to improved postfracture care.
METHODS
We conducted a randomized controlled trial (ClinicalTrials.gov identifier NCT00594789) in the province of Manitoba, Canada, from June 2008 to May 2010. Using medical claims data, we identified 4264 men and women age 50 years or older who recently reported major fractures, and who had not undergone recent bone mineral density testing or treatment for osteoporosis. Participants were randomized to three groups: group 1 received usual care (n = 1480), patients in group 2 had mailed notification of the fracture sent to their primary care physicians (n = 1363), and group 3 had notifications sent to both physicians and patients (n = 1421). Bone mineral density testing and the start of pharmacologic treatment for osteoporosis within the following 12 months were documented.
RESULTS
Among participants in group 1 (usual care), 15.8% of women and 7.6% of men underwent testing for bone mineral density or started pharmacologic treatment for osteoporosis. Outcome measures improved among participants in group 2 (30.3% of women and 19.0% of men, both p < 0.001) and group 3 (34.0% of women and 19.8% of men, both p < 0.001). No additional benefit was seen with patient notification in addition to physician notification. Combining groups 2 and 3, the absolute increase for the combined end point of bone mineral density testing or pharmacologic treatment was 14.9% (16.4% among women, 11.8% among men). The number needed to notify to change patient care was 7 (6 for women, 6 for men). The adjusted odds ratio (OR) to change patient care in group 2 was 2.45 (95% confidence interval [CI] 2.01-2.98); for group 3 the OR was 2.82 (95% CI 2.33-3.43).
INTERPRETATION
This notification system provides a relatively simple way to enhance post-fracture care.
背景
骨折后护理并不理想，因此有必要制定策略来解决这一主要护理缺口。我们研究了通过邮寄通知医生和患者是否会改善骨折后的护理。
方法
我们在加拿大马尼托巴省进行了一项随机对照试验（ClinicalTrials.gov 标识符 NCT00594789），时间为 2008 年 6 月至 2010 年 5 月。使用医疗索赔数据，我们确定了 4264 名年龄在 50 岁或以上的男女，他们最近报告了主要骨折，且最近没有进行骨密度测试或骨质疏松症治疗。参与者被随机分为三组：第 1 组接受常规护理（n = 1480），第 2 组患者的骨折通知邮寄给他们的初级保健医生（n = 1363），第 3 组通知同时寄给医生和患者（n = 1421）。记录了接下来 12 个月内的骨密度测试和开始骨质疏松症药物治疗情况。
结果
在第 1 组（常规护理）的参与者中，15.8%的女性和 7.6%的男性接受了骨密度测试或开始骨质疏松症药物治疗。第 2 组（30.3%的女性和 19.0%的男性，均 p < 0.001）和第 3 组（34.0%的女性和 19.8%的男性，均 p < 0.001）的参与者的结果均有所改善。患者通知与医生通知相结合并未带来额外的益处。将第 2 组和第 3 组结合起来，骨密度测试或药物治疗的联合终点的绝对增加为 14.9%（女性增加 16.4%，男性增加 11.8%）。需要通知的人数为 7 人（女性 6 人，男性 6 人）。第 2 组改变患者护理的调整后比值比（OR）为 2.45（95%置信区间 [CI] 2.01-2.98）；第 3 组的 OR 为 2.82（95% CI 2.33-3.43）。
解释
这种通知系统为改善骨折后护理提供了一种相对简单的方法。
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