A quasi-experimental study about shared decision-making and motivational interviewing on patients with a recent fracture attending Fracture Liaison Services.

Autor:	Maas L; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht, The Netherlands., Hiligsmann M; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht, The Netherlands., Wyers CE; Department of Internal Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands.; Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands., Bours S; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands., van der Weijden T; Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), 6200 MD Maastricht, The Netherlands., van den Bergh JP; Department of Internal Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands.; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands., van Oostwaard M; Department of Internal Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands.; Department of Internal Medicine, NUTRIM, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands., van Kuijk SMJ; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands., Boonen A; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht, The Netherlands.; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research [J Bone Miner Res] 2024 Oct 29; Vol. 39 (11), pp. 1584-1595.
DOI:	10.1093/jbmr/zjae161
Abstrakt:	Shared decision-making (SDM) aims to improve patients' experiences with care, treatment adherence, and health outcomes. However, the effectiveness of SDM in patients with a recent fracture who require anti-osteoporosis medication (AOM) is unclear. The objective of this study was to assess the effectiveness of a multicomponent adherence intervention (MCAI) including a patient decision aid (PDA) and motivational interviewing at Fracture Liaison Services (FLS) on multiple outcomes compared with usual care (UC). This pre-post superiority study included patients with a recent fracture attending FLS and with AOM treatment indication. The primary outcome was 1-year AOM persistence measured by pharmacy records. Secondary outcomes included treatment initiation, AOM adherence (measured by medication possession ratio [MPR]), decision quality (SDM process; 0-100, best), and decisional conflict (0-100, highest conflict), subsequent fractures, and mortality. Outcomes were tested in MCAI and UC groups at the first FLS visit and 4 and 12 months afterwards. Multiple imputation and uni- and multivariable analyses were performed. Post hoc analyses assessed the role of health literacy level. In total, 245 patients (MCAI: n = 136, UC: n = 109) were included. AOM persistence was 80.4% in the MCAI and 76.7% in the UC group (p=.626). SDM process scores were significantly better in MCAI (60.4 vs 55.1; p = .003). AOM initiation (97.8% vs 97.5%), MPR (90.9% vs 88.3%, p=.582), and decisional conflict (21.7 vs 23.0; p = .314) did not differ between groups. Results did not change importantly after adjustment. Stratified analyses by health literacy showed a better effect on MPR and SDM in those with adequate health literacy. This study showed no significant effect on AOM persistence; however, it demonstrated a significant positive effect of MCAI on SDM process in FLS attendees. (Netherlands Trial Registry, Trial NL7236 [NTR7435]; version 1.0; 26-11-2020 https://onderzoekmetmensen.nl/nl/trial/22858). (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)
Databáze:	MEDLINE
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