Fu Shau-Huai, Lai Wei-Jhen, Yen Hung-Kuan, Kukreti Shikha, Li Chung-Yi, Hung Chih-Chien, Wang Chen-Yu
Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan.
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Arch Osteoporos. 2025 Jan 28;20(1):15. doi: 10.1007/s11657-025-01498-4.
Rural communities face healthcare challenges. This study assessed a multicomponent intervention to improve hospital visits and anti-osteoporosis medication (AOM) treatment rates. A total of 567 patients were randomized into three groups. Results showed significant improvements in hospital attendance and AOM treatment in intervention groups compared to usual care group.
Rural communities face limited healthcare access, financial constraints, and transportation barriers leading to health disparities. This study examined interventions that reduced health disparities in increasing the outpatient attendance and treatment rate of anti-osteoporosis medication (AOM), while identifying factors contributing to therapy refusal in rural communities.
A total of 567 patients were randomized at the community level into three groups: multicomponent integrated care (MIC), osteoporosis care only (OC), and usual care (UC). Fracture Risk Assessment Tool and dual-energy X-ray absorptiometry scans were used to evaluate the osteoporosis and osteoporotic fracture risk. High- and moderate-risk patients were advised to pursue further hospital-based assessments and treatment. Both the MIC and OC groups received five interventions to address rural barriers, including specialist access, disease education, overcoming transportation barriers, peer support, and dedicated case managers. However, UC excluded transportation assistance, peer support, and case management. Outcomes measured included outpatient attendance, AOM treatment rates, and factors affecting hospital assessment refusal, analyzed via multivariable logistic modeling.
In the MIC group, 73.3% of patients attended the outpatient clinic and 58.6% received AOM. In the OC group, 81% patients attended and 69.3% received AOM. Conversely, in the UC group, only 4.1% attended and received AOM. Significant differences in attendance and AOM rates were found between the MIC and UC groups and between the OC and UC groups (p < .001 for both). Common barriers included beliefs that treatment was unnecessary and lack of hospital access. Risk factors hindering outpatient attendance include male sex, low education, low budget, multiple disabilities, and osteopenia diagnosis.
Addressing transportation barriers and implementing dedicated case management are crucial for improving healthcare access among rural patients.
ClinicalTrials.gov NCT05104034.
农村社区面临医疗保健挑战。本研究评估了一项多组分干预措施，以提高医院就诊率和抗骨质疏松药物（AOM）治疗率。总共567名患者被随机分为三组。结果显示，与常规护理组相比，干预组的医院就诊率和AOM治疗率有显著改善。
农村社区面临医疗保健机会有限、经济限制和交通障碍，导致健康差距。本研究考察了在提高抗骨质疏松药物（AOM）门诊就诊率和治疗率方面减少健康差距的干预措施，同时确定农村社区中导致拒绝治疗的因素。
总共567名患者在社区层面被随机分为三组：多组分综合护理（MIC）组、仅骨质疏松护理（OC）组和常规护理（UC）组。使用骨折风险评估工具和双能X线吸收测定扫描来评估骨质疏松症和骨质疏松性骨折风险。建议高危和中危患者进行进一步的基于医院的评估和治疗。MIC组和OC组都接受了五项干预措施，以解决农村地区的障碍，包括获得专科医生服务、疾病教育、克服交通障碍、同伴支持和专门的病例管理人员。然而，UC组不包括交通援助、同伴支持和病例管理。测量的结果包括门诊就诊率、AOM治疗率以及影响拒绝医院评估的因素，通过多变量逻辑模型进行分析。
在MIC组中，73.3%的患者到门诊就诊，58.6%的患者接受了AOM治疗。在OC组中，81%的患者就诊，69.3%的患者接受了AOM治疗。相反，在UC组中，只有4.1%的患者就诊并接受了AOM治疗。在MIC组和UC组之间以及OC组和UC组之间，就诊率和AOM治疗率存在显著差异（两者p均<0.001）。常见障碍包括认为治疗不必要和无法获得医院服务。阻碍门诊就诊的风险因素包括男性、低教育水平（低学历）、低预算、多种残疾以及骨质减少诊断。
解决交通障碍和实施专门的病例管理对于改善农村患者的医疗保健机会至关重要。
ClinicalTrials.gov NCT05104034。
