Ali Anum, Huszti Ella, Noordin Shahryar, Bogoch Earl, Yang Alan, Jain Ravi, Weldon Jennifer, Sale Joanna E M
Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor- 155 College Street, Toronto, ON, M5T 3M6, Canada.
Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada.
Arch Osteoporos. 2025 Feb 19;20(1):28. doi: 10.1007/s11657-025-01503-w.
We compared medication prescription and initiation proportions among high-risk Fracture Screening and Prevention Program patients with multiple chronic conditions. Patients with two conditions were more likely to receive prescriptions and initiate prescribed medication than those with none. Post hoc analysis showed that patients with ≥ 3 conditions were less likely to be prescribed and to initiate medication, compared to those with two conditions. Tailored interventions are important for improving post-fracture care outcomes.
To investigate the association between the number of chronic conditions and pharmacological treatment outcomes in high-risk patients who were screened through the Fracture Screening and Prevention Program (FSPP).
A retrospective cohort study was employed to determine the association between the number of chronic conditions and treatment outcomes. All high-risk patients who were enrolled in the FSPP between June 1, 2017, and June 30, 2022, were included in the study. The number of self-reported chronic conditions available in the FSPP data was classified into four categories: (1) 0 condition; (2) 1 condition; (3) 2 conditions; and (4) ≥ 3 conditions. Multivariable logistic regression models were created with prescription and initiation as outcomes.
In total, 11,245 patients were identified as high-risk for future fracture. Patients with two chronic conditions demonstrated a 26% higher odds of receiving a medication prescription, and those with two chronic conditions and prescribed bone-active medication had a 57% increased odds of initiating the treatment compared to individuals without chronic conditions. No significant differences in medication prescription or initiation were seen in those with 1 or ≥ 3 chronic conditions compared to those without chronic conditions. In post hoc testing, we saw a 25-30% significantly lower odds of medication prescription and initiation in patients reporting ≥ 3 chronic conditions when compared to those who reported only two chronic conditions.
The findings suggest that a large provincial secondary fracture prevention program resulted in higher odds of prescription and initiation of treatment in patients with two chronic conditions compared to those having no chronic conditions. Potential inequities in these treatment outcomes were found with a threshold of three or more chronic conditions. This highlights the need for tailored interventions and comprehensive support systems to improve fracture prevention outcomes for high-risk patients with multiple chronic conditions.
我们比较了患有多种慢性病的骨折筛查与预防项目高危患者的药物处方及起始用药比例。患有两种疾病的患者比无疾病患者更有可能接受处方并开始使用处方药。事后分析表明，与患有两种疾病的患者相比，患有≥3种疾病的患者开具处方和开始用药的可能性较小。量身定制的干预措施对于改善骨折后护理结果很重要。
研究通过骨折筛查与预防项目（FSPP）筛查出的高危患者中慢性病数量与药物治疗结果之间的关联。
采用回顾性队列研究来确定慢性病数量与治疗结果之间的关联。2017年6月1日至2022年6月30日期间纳入FSPP的所有高危患者均纳入本研究。FSPP数据中自我报告的慢性病数量分为四类：（1）0种疾病；（2）1种疾病；（3）2种疾病；（4）≥3种疾病。以处方和起始用药为结果创建多变量逻辑回归模型。
总共确定了11245名患者为未来骨折高危患者。与无慢性病的个体相比，患有两种慢性病的患者接受药物处方的几率高26%，患有两种慢性病且开具了骨活性药物处方的患者开始治疗的几率增加57%。与无慢性病的患者相比，患有1种或≥3种慢性病的患者在药物处方或起始用药方面没有显著差异。在事后测试中，我们发现报告≥3种慢性病患者的药物处方和起始用药几率比仅报告两种慢性病的患者显著低25%-30%。
研究结果表明，与无慢性病的患者相比，一个大型省级二级骨折预防项目使患有两种慢性病患者的处方和起始治疗几率更高。在慢性病数量达到三种或更多时，发现了这些治疗结果中潜在的不公平现象。这凸显了需要量身定制的干预措施和全面的支持系统，以改善患有多种慢性病的高危患者的骨折预防结果。
