Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Dr. David Hanley Osteoporosis Centre, Alberta Health Services, Calgary, Alberta, Canada.
Arch Osteoporos. 2020 Sep 5;15(1):138. doi: 10.1007/s11657-020-00809-1.
Many individuals prescribed osteoporosis pharmacotherapy either do not start or do not persist with treatment. In this study, women who attended a group medical visit at an osteoporosis center which involved fracture risk assessment and focused on autonomous decision-making made treatment decisions with high confidence. Those who started pharmacotherapy were highly persistent.
Adherence and persistence with osteoporosis pharmacotherapy is low, possibly reflecting lack of confidence in physicians' treatment recommendations. We evaluated treatment decisions, decisional confidence, and 12-month treatment adherence among women who attended a group bone health consultation that fostered autonomous decision-making.
We prospectively assessed postmenopausal women referred to an osteoporosis clinic who chose to attend a group medical visit in lieu of one-on-one consultation. The group visit was facilitated by a specialist physician and nurse, involving estimation of 10-year major osteoporotic fracture risk (using FRAX®) and extensive education regarding fracture consequences and potential advantages and disadvantages of pharmacotherapy. No direct advice was given by the specialist. Post-consult, participants made an autonomous decision regarding treatment intent and followed up with their family physician to enact their chosen plan. Intentions to initiate pharmacotherapy were assessed immediately post-consult. Treatment status and decisional confidence were evaluated 3 and 12 months later. Three-month treatment status was considered to reflect final treatment decision. Persistence was defined as proportion of participants on treatment at 3 months who remained treated at 12 months.
One hundred one women (mean (SD) age, 62.7 years (5.8); median (IQR) FRAX®, 10.7% (8.3-17.6)) participated. Immediately post-consult, 27 (26.7%) intended to initiate treatment. At 3 months, 23 (22.8%) were treated, and at 12 months, 21 (91.3%) remained persistent. Of 89 questionnaire respondents at 12 months, 85 (95.5%) reported confidence in their treatment decision.
When postmenopausal women are provided with individualized fracture risk estimates and enabled to make autonomous decisions regarding pharmacotherapy, ultimate decisions to receive treatment are made with confidence and result in high persistence at 12 months.
骨质疏松症药物治疗的依从性和持久性较低，这可能反映出患者对医生治疗建议缺乏信心。我们评估了参加促进自主决策的团体骨健康咨询的绝经后妇女的治疗决策、决策信心和 12 个月的治疗依从性。
我们前瞻性评估了被转诊到骨质疏松症诊所的绝经后妇女，这些妇女选择参加团体医疗就诊，而不是一对一咨询。团体就诊由一名专科医生和护士协助进行，包括估计 10 年主要骨质疏松性骨折风险（使用 FRAX®）以及广泛的关于骨折后果和药物治疗潜在利弊的教育。专科医生不提供直接建议。咨询后，参与者根据自己的意愿自主决定治疗意向，并与家庭医生跟进以实施他们选择的计划。咨询后立即评估开始药物治疗的意向。3 个月和 12 个月后评估治疗状况和决策信心。3 个月的治疗状况被认为反映了最终的治疗决策。持久性定义为 3 个月时接受治疗的参与者中，在 12 个月时仍接受治疗的比例。
101 名女性（平均（SD）年龄 62.7 岁（5.8）；中位数（IQR）FRAX®，10.7%（8.3-17.6））参加了研究。咨询后立即，27 名（26.7%）女性打算开始治疗。3 个月时，23 名（22.8%）接受了治疗，12 个月时，21 名（91.3%）保持了持久性。在 12 个月时，89 名问卷回答者中有 85 名（95.5%）报告对他们的治疗决策有信心。
当绝经后妇女获得个体化的骨折风险估计并能够自主决定药物治疗时，她们最终接受治疗的决策是有信心的，并在 12 个月时保持较高的持久性。
