Cram P, Wolinsky F D, Lou Y, Edmonds S W, Hall S F, Roblin D W, Wright N C, Jones M P, Saag K G
Department of Medicine, University of Toronto, Toronto, Canada.
Division of General Internal Medicine, Mt. Sinai/UHN Hospitals, Toronto, Canada.
Osteoporos Int. 2016 Dec;27(12):3513-3524. doi: 10.1007/s00198-016-3681-9. Epub 2016 Jun 30.
Patients often do not know or understand their bone density test results, and pharmacological treatment rates are low. In a clinical trial of 7749 patients, we used a tailored patient-activation result letter accompanied by a bone health brochure to improve appropriate pharmacological treatment. Treatment rates, however, did not improve.
Patients often do not know or understand their dual-energy x-ray absorptiometry (DXA) test results, which may lead to suboptimal care. We tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline-concordant pharmacological treatment compared to usual care only.
We conducted a randomized, controlled, double-blinded, pragmatic clinical trial at three health care centers in the USA. We randomized 7749 patients ≥50 years old and presenting for DXA between February 2012 and August 2014. The primary clinical endpoint at 12 and 52 weeks post-DXA was receiving guideline-concordant pharmacological treatment. We also examined four of the steps along the pathway from DXA testing to that clinical endpoint, including (1) receiving and (2) understanding their DXA results and (3) having subsequent contact with their provider and (4) discussing their results and options.
Mean age was 66.6 years, 83.8 % were women, and 75.3 % were non-Hispanic whites. Intention-to-treat analyses revealed that guideline-concordant pharmacological treatment was not improved at either 12 weeks (65.1 vs. 64.3 %, p = 0.506) or 52 weeks (65.2 vs. 63.8 %, p = 0.250) post-DXA, even though patients in the intervention group were more likely (all p < 0.001) to recall receiving their DXA results letter at 12 weeks, correctly identify their results at 12 and 52 weeks, have contact with their provider at 52 weeks, and have discussed their results with their provider at 12 and 52 weeks.
A tailored DXA result letter and educational brochure failed to improve guideline-concordant care in patients who received DXA.
患者通常不了解或不明白自己的骨密度检测结果，药物治疗率较低。在一项针对7749名患者的临床试验中，我们使用了一份定制的患者激活结果信，并附带一份骨骼健康手册，以改善适当的药物治疗。然而，治疗率并未提高。
患者通常不了解或不明白自己的双能X线吸收法（DXA）检测结果，这可能导致治疗效果欠佳。我们测试了与仅常规护理相比，在常规护理基础上增加一份定制的患者激活DXA结果信并附带一份教育手册，是否会改善符合指南的药物治疗。
我们在美国的三个医疗中心进行了一项随机、对照、双盲、实用的临床试验。我们将2012年2月至2014年8月期间前来进行DXA检测的7749名年龄≥50岁的患者进行随机分组。DXA检测后12周和52周的主要临床终点是接受符合指南的药物治疗。我们还检查了从DXA检测到该临床终点这一过程中的四个步骤，包括（1）收到并（2）理解他们的DXA结果，以及（3）随后与他们的医疗服务提供者联系，和（4）讨论他们的结果及选择。
平均年龄为66.6岁，83.8%为女性，75.3%为非西班牙裔白人。意向性分析显示，DXA检测后12周（65.1%对64.3%，p = 0.506）或52周（65.2%对63.8%，p = 0.250）时，符合指南的药物治疗均未得到改善，尽管干预组的患者在12周时更有可能（所有p < 0.001）回忆起收到了他们的DXA结果信，在12周和52周时正确识别自己的结果，在52周时与他们的医疗服务提供者联系，以及在12周和52周时与他们的医疗服务提供者讨论他们的结果。
一份定制的DXA结果信和教育手册未能改善接受DXA检测患者的符合指南的护理。
