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A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis

机译:知识翻译工具可改善初级保健中的骨质疏松症疾病管理:时间序列中断分析

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Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians. Methods The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ?50 years, men aged ?65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance. Results The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P?
机译:背景骨质疏松症以高昂的成本影响了全球2亿多人的医疗保健系统,但管理方面的差距仍然存在。作为回应,我们开发了一种多组分骨质疏松知识翻译(Op-KT)工具,其中包括患者发起的风险评估调查表(RAQ),可为医生提供个性化的最佳实践建议,并在护理时为患者提供个性化的教育。本研究的目的是评估Op-KT工具对医师进行适当疾病管理的有效性。方法使用中断时间序列设计对Op-KT工具进行了评估。这涉及对工具实施之前(基准)的12个月和实施工具之后12个月的结果进行多次评估(总共52个数据点)。入选标准为家庭医生及其有骨质疏松症风险的患者(女性年龄≥50岁,男性年龄≥65岁)。主要结果是开始适当的骨质疏松症筛查和治疗。分析包括分段线性回归建模和方差分析。结果Op-KT工具在加拿大安大略省的三个家庭诊所中实施,代表5位家庭医生和2840位年龄相关的患者(平均年龄67岁;女性占76%)。时间序列回归模型显示,筛查开始时基线水平总体增加(3.4%; P <0.001),任何骨质疏松药物(0.5%; P = 0.006)以及钙或维生素D(1.2%; P ==?0.001)。在所考虑的所有三个站点的站点级别上也都观察到了改进,但是这些结果在各个站点之间有所不同。在351位无提示地完成RAQ的患者中(平均年龄64岁,女性为77%),平均完成RAQ的时间为3.43分钟,其中56%的患者接受了医生的任何疾病处理。与随机试验相比,研究的局限性包括我们设计的固有敏感性。结论多组分Op-KT工具在三种家庭实践中显着增加了骨质疏松症的调查,并强调了其促进患者自我管理的潜力。后续步骤包括更广泛地实施和评估初级保健中的工具。

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