关于骨骼健康的“即时”护士咨询评估：一项试点随机对照试验。
Evaluation of a "Just-in-Time" Nurse Consultation on Bone Health: A Pilot Randomized Controlled Trial.
作者信息
Roblin Douglas W, Zelman David, Plummer Sally, Robinson Brandi E, Lou Yiyue, Edmonds Stephanie W, Wolinsky Fredric D, Saag Kenneth G, Cram Peter
机构信息
Professor of Health Management and Policy at Georgia State University School of Public Health and a Consulting Senior Research Scientist at the Center for Clinical and Outcomes Research in Atlanta.
At the time of this study was a Rheumatologist with The Southeast Permanente Medical Group, Inc, in Atlanta, GA.
出版信息
Perm J. 2017;21:16-112. doi: 10.7812/TPP/16-112.
CONTEXT
Evidence is inconclusive whether a nurse consultation can improve osteoporosis-related patient outcomes.
OBJECTIVE
To evaluate whether a nurse consultation immediately after dual-energy x-ray absorptiometry (DXA) produced better osteoporosis-related outcomes than a simple intervention to activate adults in good bone health practices or usual care.
DESIGN
Pilot randomized controlled trial, conducted within the larger Patient Activation After DXA Result Notification (PAADRN) trial (NCT01507662). After DXA, consenting adults age 50 years or older were randomly assigned to 3 groups: nurse consultation, PAADRN intervention (mailed letter with individualized fracture risk and an educational brochure), or usual care (control). Nurse consultation included reviewing DXA results, counseling on bone health, and ordering needed follow-up tests or physician referrals.
MAIN OUTCOME MEASURES
Change from baseline to 52 weeks in participant-reported osteoporosis-related pharmacotherapy, lifestyle, activation and self-efficacy, and osteoporosis care satisfaction.
RESULTS
Nurse consultation participants (n = 104) reported 52-week improvements in strengthening and weight-bearing exercise (p = 0.09), calcium intake (p < 0.01), osteoporosis knowledge (p = 0.04), activation (p < 0.01), dietary self-efficacy (p = 0.06), and osteoporosis care satisfaction (p < 0.01). Compared with PAADRN intervention participants (n = 39), nurse consultation participants had improved dietary self-efficacy (p = 0.07) and osteoporosis care satisfaction (p = 0.05). No significant improvements in osteoporosis-related outcomes were achieved vs PAADRN controls (n = 70).
CONCLUSION
"Just-in-time" nurse consultation yielded a few improvements over 52 weeks in osteoporosis-related outcomes; however, most changes were not different from those obtained through the lower-cost PAADRN intervention or usual care.
背景
护士咨询能否改善骨质疏松症相关的患者预后，证据尚无定论。
目的
评估在双能X线吸收法（DXA）检查后立即进行护士咨询，与单纯采取干预措施以促使骨骼健康状况良好的成年人养成良好的骨骼健康习惯或接受常规护理相比，是否能产生更好的骨质疏松症相关预后。
设计
先导性随机对照试验，在规模更大的DXA结果通知后的患者激活（PAADRN）试验（NCT01507662）中进行。DXA检查后，年龄在50岁及以上的同意参与的成年人被随机分为3组：护士咨询组、PAADRN干预组（邮寄包含个体骨折风险的信件和一份教育手册）或常规护理组（对照组）。护士咨询包括审查DXA结果、提供骨骼健康咨询以及安排所需的后续检查或转介给医生。
主要结局指标
参与者报告的骨质疏松症相关药物治疗、生活方式、激活和自我效能以及骨质疏松症护理满意度从基线到52周的变化。
结果
护士咨询组参与者（n = 104）报告在强化和负重锻炼（p = 0.09）、钙摄入量（p < 0.01）、骨质疏松症知识（p = 0.04）、激活（p < 0.01）、饮食自我效能（p = 0.06）和骨质疏松症护理满意度（p < 0.01）方面有52周的改善。与PAADRN干预组参与者（n = 39）相比，护士咨询组参与者的饮食自我效能（p = 0.07）和骨质疏松症护理满意度（p = 0.05）有所提高。与PAADRN对照组（n = 70）相比，骨质疏松症相关结局未取得显著改善。
结论
“及时”的护士咨询在52周内使骨质疏松症相关结局有了一些改善；然而，大多数变化与通过成本较低的PAADRN干预或常规护理所获得的变化并无差异。
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