Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
Hospices Civils de Lyon, Pôle de Santé Publique, 69003, Lyon, France.
Osteoporos Int. 2020 Mar;31(3):429-446. doi: 10.1007/s00198-020-05308-0. Epub 2020 Jan 28.
Osteoporosis (OP) is a major public health concern, but still OP care does not meet guidelines. Interventions have been developed to improve appropriate OP management. The objective of the present study was to systematically review the current literature to ascertain the efficacy of interventions to improve OP care and characterize interventions taking into account elements related to their potential cost and feasibility. Studies published from 2003 to 2018 were retrieved from PubMed/MEDLINE, Science Direct, Web of Science, Cochrane, and Wiley Online Library databases. Screening of references and quality assessment were independently performed by two reviewers. We classified interventions into three types according to the target of the intervention: health system (structural interventions), healthcare professional (HCP), and patient. Meta-analysis was performed by type of intervention and their effect on two outcomes: prescription of BMD measurement and prescription of OP therapy. A total of 4268 records were screened; 32 studies were included in the qualitative analysis and 29 studies in the quantitative analysis. Structural interventions strongly and significantly improved prescription of BMD measurement (OR = 9.99, 95% CI 2.05; 48.59) and treatment prescription (OR = 3.82, 95% CI 2.16; 6.75). The impact of HCP-centered interventions on BMD measurement prescription did not reach statistical significance (OR = 2.19, 95% CI 0.84; 5.73) but significantly improved treatment prescription (OR = 3.82, 95% CI 2.16; 6.75). Interventions involving patients significantly improved the prescription of BMD measurement (OR = 2.16, 95% CI 1.62; 2.89) and treatment prescription (OR = 1.70, 95% CI 1.35; 2.14). Interventions to improve OP management had a significant positive impact on prescription of BMD measurement but a more limited impact on treatment prescription.
骨质疏松症（OP）是一个主要的公共卫生问题，但OP 护理仍然不符合指南。已经开发了干预措施来改善适当的 OP 管理。本研究的目的是系统地回顾当前文献，以确定改善 OP 护理的干预措施的疗效，并根据与潜在成本和可行性相关的因素对干预措施进行特征描述。从 2003 年至 2018 年，从 PubMed/MEDLINE、Science Direct、Web of Science、Cochrane 和 Wiley Online Library 数据库中检索到研究。两名审查员独立进行了参考文献筛选和质量评估。我们根据干预目标将干预措施分为三类：卫生系统（结构性干预）、医疗保健专业人员（HCP）和患者。通过干预类型及其对两个结果的影响进行荟萃分析：BMD 测量的处方和 OP 治疗的处方。共筛选了 4268 条记录；32 项研究纳入定性分析，29 项研究纳入定量分析。结构性干预措施显著改善了 BMD 测量的处方（OR=9.99，95%CI 2.05；48.59）和治疗处方（OR=3.82，95%CI 2.16；6.75）。以 HCP 为中心的干预措施对 BMD 测量处方的影响未达到统计学意义（OR=2.19，95%CI 0.84；5.73），但显著改善了治疗处方（OR=3.82，95%CI 2.16；6.75）。涉及患者的干预措施显著改善了 BMD 测量的处方（OR=2.16，95%CI 1.62；2.89）和治疗处方（OR=1.70，95%CI 1.35；2.14）。改善 OP 管理的干预措施对 BMD 测量的处方有显著的积极影响，但对治疗处方的影响更为有限。
