Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial
| Autor: | Thomas M. Jaeger, Gregory A. Bartel, Laurie J. Pencille, Sidna M. Tulledge-Scheitel, Brian A. Swiglo, L. Joseph Melton, Holly K. Van Houten, Megan E. Branda, Robert A. Wermers, Nilay Shah, Rebecca L. Kesman, Victor M. Montori, Ruth E. Johnson |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Health Knowledge Attitudes Practice Osteoporosis Decision Making Trust Risk Assessment law.invention Decision Support Techniques Medication Adherence Randomized controlled trial law Bone Density Risk Factors Internal medicine medicine Humans Medical prescription Patient participation Osteoporosis Postmenopausal Aged Aged 80 and over Bone Density Conservation Agents Diphosphonates Primary Health Care business.industry Medical record Absolute risk reduction General Medicine Middle Aged medicine.disease Clinical trial Physical therapy Female Patient Participation Risk assessment business Osteoporotic Fractures |
| Zdroj: | The American journal of medicine. 124(6) |
| ISSN: | 1555-7162 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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