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




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Implementation Science

, 9:109

First Online: 25 September 2014Received: 16 November 2013Accepted: 11 August 2014DOI: 10.1186-s13012-014-0109-9

Cite this article as: Kastner, M., Sawka, A.M., Hamid, J. et al. Implementation Sci 2014 9: 109. doi:10.1186-s13012-014-0109-9

Abstract

BackgroundOsteoporosis 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.

MethodsThe 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.

ResultsThe 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 < 0.001, any osteoporosis medications 0.5%; P = 0.006, and calcium or vitamin D 1.2%; P = 0.001. Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted mean age 64 years, 77% women, the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial.

ConclusionsThe multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.

KeywordsKnowledge translation Clinical decision support Chronic disease management Primary care Risk assessment Osteoporosis Interrupted time series analysis Electronic supplementary materialThe online version of this article doi:10.1186-s13012-014-0109-9 contains supplementary material, which is available to authorized users.

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Author: Monika Kastner - Anna M Sawka - Jemila Hamid - Maggie Chen - Kevin Thorpe - Mark Chignell - Joycelyne Ewusie - Christine 

Source: https://link.springer.com/







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