Use of a Decision Aid to Improve Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial
Use of a Decision Aid to Improve Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial
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DOI：
10.1016/j.amjmed.2011.01.013
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发表时间：
2011-06-01
影响因子：
5.9
通讯作者：
Wermers, Robert A.
中科院分区：
文献类型：
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作者：
Montori, Victor M.;Shah, Nilay D.;Wermers, Robert A.
目的：治疗依从性差，可能与未解决患者偏好有关，限制了高危女性骨质疏松症治疗的有效性。在初级保健实践中进行了一项平行的患者水平随机试验。方法：纳入骨矿物质密度 T 分数低于 -1.0 且未接受双膦酸盐治疗的符合条件的绝经后妇女。除了常规的初级护理外，干预患者还接受了决策辅助（量身定制的象形图 10 年骨折风险评估、双磷酸盐的绝对风险降低、副作用和自付费用），对照患者收到了标准手册。研究了知识转移、患者参与决策以及双膦酸盐开始使用和坚持使用的比率。数据来自医疗记录、就诊后书面调查和 6 个月电话调查、临床就诊视频记录以及药房处方资料。 结果：共有 100 名患者（10 年骨折风险范围为 6%-60%）被随机分配接受决策援助 (n = 52) 或常规护理 (n = 48)。接受决策援助的患者正确识别其 10 年骨折风险的可能性高出 1.8 倍（49% vs 28%；95% 置信区间 [CI]，1.03-3.2），并且识别双磷酸盐治疗后估计风险降低的可能性高出 2.7 倍（43% vs 16%；95% CI，1.3-5.7）。决策辅助使患者参与度提高了 23%（95% CI，13.6-31.4）。 44% 接受决策援助的患者和 40% 接受常规护理的患者开始使用双磷酸盐。两组的 6 个月依从性相似，但使用决策辅助的比例超过 80% 的比例更高（n = 23 [100%] vs n = 14 [74%]；P = 0.009）。结论：决策辅助提高了高危绝经后妇女双磷酸盐治疗的临床决策质量，不影响开始率，并且可能提高了依从性。 (C) 2011 Elsevier Inc. 保留所有权利。美国医学杂志 (2011) 124, 549-556
OBJECTIVE: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed.METHODS: Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles.RESULTS: A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n = 52) or usual care (n = 48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n = 23 [100%] vs n = 14 [74%]; P = .009).CONCLUSION: A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 549-556