Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.

Autor: Kennedy CC; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. kennedyc@hhsc.ca., Ioannidis G; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. g.ioannidis@sympatico.ca., Thabane L; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. thabanl@mcmaster.ca., Adachi JD; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. adachi@sympatico.ca., Marr S; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. marrs@mcmaster.ca., Giangregorio LM; University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. lmgiangr@uwaterloo.ca., Morin SN; McGill University, 845Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada. suzanne.morin@mcgill.ca., Crilly RG; Western University, Parkwood Hospital, 801 Commissioners Road East, London, ON, N6C 5 J1, Canada. crilly@sjhc.london.on.ca., Josse RG; University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. josser@smh.toronto.on.ca., Lohfeld L; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. lohfeld@mcmaster.ca., Pickard LE; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. pickardl@hhsc.ca., van der Horst ML; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. dhm9@xplornet.com., Campbell G; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ecampbell49@quickclic.net., Stroud J; Medical Pharmacies Group Limited, 590 Granite Crt, Pickering, ON, L1W 3X6, Canada. jstroud@medicalpharmacies.com., Dolovich L; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. ldolovic@mcmaster.ca., Sawka AM; University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. sawka@uhn.on.ca., Jain R; Osteoporosis Canada, Suite 301, 1090 Don Mills Road, Toronto, ON, M3C 3R6, Canada. RJain@osteoporosis.ca., Nash L; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. nashl@mcmaster.ca., Papaioannou A; McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. papaioannou@hhsc.ca.; Division of Geriatrics, Department of Medicine, McMaster University, Geriatric Education and Research in Aging Sciences (GERAS) Centre, St. Peter's Hospital, Room 151, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. papaioannou@hhsc.ca.
Jazyk: angličtina
Zdroj: Trials [Trials] 2015 May 12; Vol. 16, pp. 214. Date of Electronic Publication: 2015 May 12.
DOI: 10.1186/s13063-015-0720-3
Abstrakt: Background: Few studies have systematically examined whether knowledge translation (KT) strategies can be successfully implemented within the long-term care (LTC) setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months.
Methods: We conducted a pilot, cluster randomized controlled trial in 40 LTC homes (21 control; 19 intervention) in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams (physicians, nurses, consultant pharmacists, and other staff) who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D (≥800 IU/daily; primary), calcium ≥500 mg/day and osteoporosis medications (high-risk residents) over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes.
Results: At baseline, 5,478 residents, mean age 84.4 (standard deviation (SD) 10.9), 71% female, resided in 40 LTC homes, mean size = 137 beds (SD 76.7). In the intention-to-treat analysis (21 control; 19 intervention clusters), the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D (odds ratio (OR) 1.82, 95% confidence interval (CI): 1.12, 2.96) and calcium (OR 1.33, 95% CI: 1.01, 1.74), but not for osteoporosis medications (OR 1.17, 95% CI: 0.91, 1.51). In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 (95% CI: 2.18, 4.29), 1.57 (95% CI: 1.12, 2.21), 1.20 (95% CI: 0.90, 1.60) for vitamin D, calcium and osteoporosis medications, respectively.
Conclusions: Our KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement.
Trial Registration: ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.
Databáze: MEDLINE
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