Kennedy Courtney C, Ioannidis George, Thabane Lehana, Adachi Jonathan D, Marr Sharon, Giangregorio Lora M, Morin Suzanne N, Crilly Richard G, Josse Robert G, Lohfeld Lynne, Pickard Laura E, van der Horst Mary-Lou, Campbell Glenda, Stroud Jackie, Dolovich Lisa, Sawka Anna M, Jain Ravi, Nash Lynn, Papaioannou Alexandra
McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
Trials. 2015 May 12;16:214. doi: 10.1186/s13063-015-0720-3.
Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months.
We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes.
At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively.
Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement.
ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.
很少有研究系统地探讨知识转化（KT）策略能否在长期护理（LTC）环境中成功实施。在本研究中，我们考察了一项多方面、跨学科的KT干预措施在12个月内改善维生素D、钙和骨质疏松症药物处方情况的效果。
我们在加拿大安大略省的40所LTC机构（21所对照；19所干预）中开展了一项试点、整群随机对照试验。LTC机构若有不止一名开处方的医生且接受大型药房供应商的服务，则符合入选条件。参与者为跨学科护理团队（医生、护士、顾问药剂师和其他工作人员），他们每季度会面一次。干预机构在12个月内参加了三次教育会议，包括由专家意见领袖主持的标准化讲座、质量改进行动计划以及审核与反馈评估。对照机构未接受任何额外干预。从药房数据库收集居民层面的处方和临床结果；数据收集者和分析者均处于盲态。除可行性指标外，研究结果为12个月内服用维生素D（≥800国际单位/天；主要指标）、钙≥500毫克/天以及骨质疏松症药物（高危居民）的居民比例。使用广义估计方程技术对数据进行分析，该技术考虑了LTC机构内部的聚类情况。
基线时，40所LTC机构中有5478名居民，平均年龄84.4岁（标准差（SD）10.9），71%为女性，机构平均规模为137张床位（SD 76.7）。在意向性分析（21所对照；19所干预组）中，干预导致干预组与对照组从基线到12个月维生素D（优势比（OR）1.82，95%置信区间（CI）：1.12，2.96）和钙（OR 1.33，95% CI：1.01，1.74）的处方增加幅度显著更大，但骨质疏松症药物方面无显著差异（OR 1.17，95% CI：0.91，1.51）。在二次分析中，排除7所未参与的干预机构后，维生素D、钙和骨质疏松症药物的OR分别为3.06（95% CI：2.18，4.29）、1.57（95% CI：1.12，2.21）、1.20（95% CI：0.90，1.60）。
我们的KT干预显著改善了维生素D和钙的处方情况，是一个有可能应用于其他需要质量改进领域的模式。
ClinicalTrials.gov：NCT01398527。注册时间：2011年7月19日。
