Kastner Monika, Sawka Anna M, Hamid Jemila, Chen Maggie, Thorpe Kevin, Chignell Mark, Ewusie Joycelyne, Marquez Christine, Newton David, Straus Sharon E
Implement Sci. 2014 Sep 25;9:109. doi: 10.1186/s13012-014-0109-9.
Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians.
The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance.
The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial.
The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.
骨质疏松症影响着全球超过2亿人，给医疗保健系统带来高昂成本，但管理方面仍存在差距。作为回应，我们开发了一种多组件骨质疏松症知识转化（Op-KT）工具，其中包括患者发起的风险评估问卷（RAQ），该问卷可为医生生成个性化的最佳实践建议，并在护理点为患者提供定制教育。本研究的目的是评估Op-KT工具对医生进行适当疾病管理的有效性。
使用中断时间序列设计对Op-KT工具进行评估。这涉及在工具实施前12个月（基线）和实施后12个月对结果进行多次评估（总共52个数据点）。纳入标准为家庭医生及其有骨质疏松症风险的患者（年龄≥50岁的女性，年龄≥65岁的男性）。主要结果是开始进行适当的骨质疏松症筛查和治疗。分析包括分段线性回归建模和方差分析。
Op-KT工具在加拿大安大略省的三个家庭医疗诊所实施，代表5名家庭医生和2840名符合年龄条件的患者（平均年龄67岁；76%为女性）。时间序列回归模型显示，筛查开始率（3.4%；P<0.001）、任何骨质疏松症药物的使用（0.5%；P=0.006）以及钙或维生素D的使用（1.2%；P=0.001）较基线总体有所增加。在所考虑的所有三个诊所层面也观察到了改善，但这些结果在不同诊所有所不同。在351名主动完成RAQ的患者中（平均年龄64岁，77%为女性），完成RAQ的平均时间为3.43分钟，56%的患者其疾病管理得到了医生的处理。研究局限性包括与随机试验相比，我们的设计存在固有易感性。
多组件Op-KT工具显著增加了三个家庭医疗诊所的骨质疏松症检查，并突出了其促进患者自我管理的潜力。下一步包括在初级保健中更广泛地实施和评估该工具。
