Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Ave, Philadelphia, PA, 19104, USA.
Osteoporos Int. 2017 Feb;28(2):567-576. doi: 10.1007/s00198-016-3767-4. Epub 2016 Sep 19.
We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care.
Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA).
We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <-1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake.
The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake.
A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients' decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.
我们在在线患者门户中测试了骨折预防决策辅助工具的可行性。决策辅助工具对患者是可接受的，并成功降低了决策冲突。这项研究表明，利用患者门户来增强骨质疏松症护理中的患者教育和决策可能具有一定的效用。
尽管干预措施已经改善了某些高危人群的骨质疏松症筛查和/或治疗，但最近的全国性研究表明，这些干预措施的大规模应用受到了限制。我们旨在确定基于患者门户的骨质疏松症决策辅助工具（DA）的可行性和潜在疗效。
我们对年龄≥55 岁且已注册患者门户且 T 评分<-1 的初级保健患者进行了一项试点随机对照试验。干预组患者提供了一个患者 DA 的链接。DA 包含一个 10 年骨折风险计算器、药物风险和益处（处方和非处方）摘要以及价值观的引出。患者完成了评估主要结局（决策冲突和决策准备）和与可行性及更大规模试验计划相关的次要结局的问卷。审查了图表以了解医生与患者的互动和药物使用情况。
DA 对患者是可接受的，但决策辅助工具组的 17%患者错误地将他们的 T 评分输入到基于 FRAX 的风险计算器中。与对照组相比，随机分配到决策辅助工具组的患者在干预后决策冲突较低（17.8 对 47.1，p<.001），且在 3 个月时做出治疗决策的患者比例有显著差异。药物使用率没有显著差异。
基于门户的骨质疏松症 DA 是可接受的，并改善了几项决策质量措施。鉴于其对改善患者决策质量的影响，未来的研究应该检查它是否能提高医生遵循指南的程度或接受治疗的患者的药物使用依从性。
