VA-Based Survey of Osteoporosis Management in Spinal Cord Injury
VA-Based Survey of Osteoporosis Management in Spinal Cord Injury
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DOI：
10.1016/j.pmrj.2008.10.008
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发表时间：
2009-03-01
期刊：
影响因子：
2.1
通讯作者：
Garshick, Eric
中科院分区：
文献类型：
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作者：
Morse, Leslie R.;Giangregorio, Lora;Garshick, Eric
目的：尽管骨质疏松症在脊髓损伤（SCI）后很常见，但目前尚无治疗、诊断或预防骨质疏松的指南。作者假设，诊断和治疗实践的广泛差异是由于缺乏指南造成的。本研究旨在描述VA医疗保健系统对脊髓损伤后骨质疏松症的诊断和管理实践。设计：关于脊髓损伤中骨质疏松管理的在线调查，包括27个问题，旨在收集应答者的人口统计信息、骨质疏松诊断和治疗方案。设置：VA医疗保健系统。参与者：VHA国家SCI工作人员医师和VHA国家SCI护士（共n = 450）被发送电子邮件邀请参加。干预：不适用。主要结果测量：评估实践模式，包括与订购临床检查和骨质疏松症治疗处方相关的因素。结果：有效率为28%。92名处方从业人员（医生、执业护士和医师助理）被纳入分析。在这些应答者中，有50人（54%）为sci诱导的骨质流失开具药物；39名（42%）医生开双膦酸盐处方，46名（50%）医生开维生素d处方。54名（59%）受访者常规要求进行诊断测试，包括50名（54%）患者的双能x线吸收仪扫描。实践中的差异不能用年龄、性别或从事脊髓损伤医学的年数来解释。许多受访者（23%）报告了骨质疏松症检测的障碍，包括缺乏扫描协议、成本、轮椅无法进入扫描设施，以及一旦诊断出骨质疏松症缺乏有效的治疗指南。结论：尽管缺乏筛查和治疗指南，但超过一半的受访者在退伍军人事务部卫生保健机构内积极诊断和治疗双膦酸盐骨质疏松症。这些数据表明，有必要制定循证实践指南，以减少实践变化，改善对这一人群的临床护理。
Objective: Although osteoporosis is common following spinal cord injury (SCI), no guidelines exist for its treatment, diagnosis, or prevention. The authors hypothesized that wide variations in diagnosis and treatment practices result from the absence of guidelines. This study sought to characterize the diagnosis and management practices within the VA health care system for osteoporosis following SCI.Design: Online survey regarding osteoporosis management in SCI composed of 27 questions designed to gather information on responder demographics, osteoporosis diagnostics, and treatment options.Setting: VA health care system.Participants: VHA National SCI Staff Physicians and VHA National SCI Nurses (total n = 450) were sent an email with an invitation to participate.Intervention: Not applicable.Main Outcome Measures: Practice patterns were assessed, including factors associated with ordering a clinical workup and prescribing osteoporosis treatment.Results: The response rate was 28%. Ninety-two prescribing practitioners (physicians, nurse practitioners, and physician assistants) were included in the analysis. Of these respondents, 50 (54%) prescribe medications for SCI-induced bone loss; 39 (42%) prescribe bisphosphonates and 46 (50%) prescribe vitamin D. There were 54 (59%) respondents who routinely order diagnostic tests, including dual energy x-ray absorptiometry scans in 50 (54%). Variations in practice were not explained by age, gender, or years practicing SCI medicine. Many respondents (23%) reported barriers to osteoporosis testing including lack of scanning protocols, cost, wheelchair inaccessibility of scanning facilities, and lack of effective treatment guidelines once osteoporosis is diagnosed.Conclusions: Despite an absence of screening and treatment guidelines, more than half of all respondents are actively diagnosing and treating osteoporosis with bisphosphonates within the VA health care setting. These data suggest that evidence-based practice guidelines are necessary to reduce practice variations and improve clinical care for this population.