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Factors Associated with Gaps in Osteoporosis Treatment

与骨质疏松症治疗差距相关的因素

基本信息

批准号：
6480317
负责人：
ADRIANNE C FELDSTEIN
金额：
$ 10万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2002
资助国家：
美国
起止时间：
2002-04-01 至 2003-09-30
项目状态：
已结题

项目摘要

The human and economic tool of osteoporotic fractures is staggering. Individuals who have had prior fractures are at increased risk of future fractures. Evidence-based clinical practice guidelines and effective treatment are readily available but incompletely utilized in this high-risk group. This is a retrospective cohort study designed to evaluate the treatment gap in older women who have had fracture associated with osteoporosis, to provide the foundation for designing in future secondary prevention programs for re-fracture. The treatment gap, as defined for this study, is that a woman does not receive pharmacologic treatment for osteoporosis. The gap may be due to clinicians not following guidelines if she either goes untreated without BMD screening, or does not receive a BMD screening and appropriate subsequent treatment, within six months of the index fracture. Or the gap may be due to the lack of patient compliance if treatment is offered but not used. The primary aims are to determine if woman aged 50-89 years with a prior study-eligible clinical fracture 1) the fraction of women with an osteoporosis treatment gap, and what fraction of the gap is due to clinicians not following the guidelines and what is fraction is due to the lack of patient compliance; 2) the distribution of treatment duration and the distribution of patient compliance; and 3) which patient, health care provider, and health care benefit characteristics available in our electronic databases are significantly associated with treatment gaps. The primary outcomes are: 1) provider initiation of treatment, whether or not within 6 months after the index fracture a pharmacologic agent for osteoporosis is dispensed, or BMD by dual x-ray absorptiometry (DXA) screening is completed followed by treatment for a femoral neck T-score at or below -2.5; and 2) for patient compliance with treatment, the percent of time after the index fracture the dispensed medication is taken. This proposal is significant because we will be able to longitudinally evaluate a large dataset of women who have had any index fractures associated with osteoporosis using clinical database. Through our extensive integrated systems we can investigate a broad range of factors for associations with osteoporosis screening, treatment, and compliance with treatment.

骨质疏松性骨折对人类和经济的影响是惊人的。以前曾发生过骨折的人未来发生骨折的风险会增加。基于证据的临床实践指南和有效的治疗很容易获得，但在这个高危人群中并未得到充分利用。这是一项回顾性队列研究，旨在评估患有骨质疏松症相关骨折的老年女性的治疗差距，为设计未来的再骨折二级预防计划奠定基础。本研究定义的治疗差距是指女性没有接受骨质疏松症药物治疗。这种差距可能是由于临床医生没有遵循指南，如果她在指数骨折后六个月内没有进行 BMD 筛查而未接受治疗，或者没有接受 BMD 筛查和适当的后续治疗。或者，如果提供治疗但未使用，则差距可能是由于患者缺乏依从性造成的。主要目的是确定年龄在 50-89 岁且之前有过临床骨折史的女性是否符合研究条件：1) 存在骨质疏松症治疗差距的女性比例，以及差距的比例是由于临床医生不遵循指南而造成的，以及比例是由于患者缺乏依从性造成的； 2）治疗持续时间的分布和患者依从性的分布； 3) 我们的电子数据库中提供的哪些患者、医疗保健提供者和医疗保健福利特征与治疗差距显着相关。主要结果是：1) 提供者开始治疗，无论是否在指数骨折后 6 个月内分配骨质疏松症药物，或完成双 X 射线骨密度测定 (DXA) 筛查的 BMD，然后进行股骨颈 T 评分等于或低于 -2.5 的治疗； 2) 对于患者对治疗的依从性，指数骨折后服用所分配药物的时间百分比。这项提议意义重大，因为我们将能够使用临床数据库纵向评估患有与骨质疏松症相关的任何指数骨折的女性的大型数据集。通过我们广泛的集成系统，我们可以调查与骨质疏松症筛查、治疗和治疗依从性相关的广泛因素。