Health Economic Assessment Network, Paris, France.
Health Economic Assessment Network, Paris, France.
Value Health. 2022 Apr;25(4):571-581. doi: 10.1016/j.jval.2021.10.005. Epub 2021 Nov 25.
This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France.
A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles.
A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, "my fracture is not related to osteoporosis," was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system).
Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.
本研究旨在量化法国骨质疏松性骨折患者在改善二级预防方面面临的障碍以及对护理的期望的相对重要性。
通过系统文献回顾和深入的患者访谈，对潜在的护理障碍和期望进行定性探索。确定了 21 个障碍和 21 个期望。这些内容以最佳最差量表问卷的形式呈现给了 324 名在法国代表性人群样本中确定的骨质疏松性骨折患者。患者对属性的相对重要性进行评分，并计算和排名算术平均值重要性得分。还进行了贝叶斯层次模型以生成相对重要性得分。进行潜在类别分析以识别具有不同反应特征的潜在患者亚组。
共有 7 个障碍被评为最重要的，与骨质疏松症的认识和护理协调有关。排名最高的障碍“我的骨折与骨质疏松症无关”，明显比其他所有障碍都重要（重要性得分 0.45；95%置信区间 0.33-0.56）。两种方法（算术和贝叶斯）均获得了类似的属性排名。对于期望，没有明确的属性层次结构。潜在类别分析区分了 3 组应答者，他们的应答特征存在显著差异（受过教育的环保主义者、无意识者和系统受害者）。
改善骨质疏松症的护理质量和有效二级骨折预防将需要改进患者教育、医疗保健专业人员的培训以及护理协调。
