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Luque Mellado FJ, Martos Molines FJ, Lebrero Villa Y. [Integral incident management system in primary care: Beyond patient safety]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2017; 32:335-341. [PMID: 29169964 DOI: 10.1016/j.cali.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/12/2017] [Accepted: 10/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation. MATERIAL AND METHOD Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months. RESULTS During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety. CONCLUSIONS The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality.
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Affiliation(s)
| | | | - Y Lebrero Villa
- Institut Català de la Salut, CAP Guineueta, Barcelona, España
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Tzortziou Brown V, Underwood M, Mohamed N, Westwood O, Morrissey D. Professional interventions for general practitioners on the management of musculoskeletal conditions. Cochrane Database Syst Rev 2016; 2016:CD007495. [PMID: 27150167 PMCID: PMC10523188 DOI: 10.1002/14651858.cd007495.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Musculoskeletal conditions require particular management skills. Identification of interventions which are effective in equipping general practitioners (GPs) with such necessary skills could translate to improved health outcomes for patients and reduced healthcare and societal costs. OBJECTIVES To determine the effectiveness of professional interventions for GPs that aim to improve the management of musculoskeletal conditions in primary care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2010, Issue 2; MEDLINE, Ovid (1950 - October 2013); EMBASE, Ovid (1980 - Ocotber 2013); CINAHL, EbscoHost (1980 - November 2013), and the EPOC Specialised Register. We conducted cited reference searches using ISI Web of Knowledge and Google Scholar; and handsearched selected issues of Arthritis and Rheumatism and Primary Care-Clinics in Office Practice. The latest search was conducted in November 2013. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) studies of professional interventions for GPs, taking place in a community setting, aiming to improve the management (including diagnosis and treatment) of musculoskeletal conditions and reporting any objective measure of GP behaviour, patient or economic outcomes. We considered professional interventions of any length, duration, intensity and complexity compared with active or inactive controls. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted all data. We calculated the risk difference (RD) and risk ratio (RR) of compliance with desired practice for dichotomous outcomes, and the mean difference (MD) and standardised mean difference (SMD) for continuous outcomes. We investigated whether the direction of the targeted behavioural change affects the effectiveness of interventions. MAIN RESULTS Thirty studies met our inclusion criteria.From 11 studies on osteoporosis, meta-analysis of five studies (high-certainty evidence) showed that a combination of a GP alerting system on a patient's increased risk of osteoporosis and a patient-directed intervention (including patient education and a reminder to see their GP) improves GP behaviour with regard to diagnostic bone mineral density (BMD) testing and osteoporosis medication prescribing (RR 4.44; (95% confidence interval (CI) 3.54 to 5.55; 3 studies; 3,386 participants)) for BMD and RR 1.71 (95% CI 1.50 to 1.94; 5 studies; 4,223 participants) for osteoporosis medication. Meta-analysis of two studies showed that GP alerting on its own also probably improves osteoporosis guideline-consistent GP behaviour (RR 4.75 (95% CI 3.62 to 6.24; 3,047 participants)) for BMD and RR 1.52 (95% CI 1.26 to 1.84; 3.047 participants) for osteoporosis medication) and that adding the patient-directed component probably does not lead to a greater effect (RR 0.94 (95% CI 0.81 to 1.09; 2,995 participants)) for BMD and RR 0.93 (95% CI 0.79 to 1.10; 2,995 participants) for osteoporosis medication.Of the 10 studies on low back pain, seven showed that guideline dissemination and educational opportunities for GPs may lead to little or no improvement with regard to guideline-consistent GP behaviour. Two studies showed that the combination of guidelines and GP feedback on the total number of investigations requested may have an effect on GP behaviour and result in a slight reduction in the number of tests, while one of these studies showed that the combination of guidelines and GP reminders attached to radiology reports may result in a small but sustained reduction in the number of investigation requests.Of the four studies on osteoarthritis, one study showed that using educationally influential physicians may result in improvement in guideline-consistent GP behaviour. Another study showed slight improvements in patient outcomes (pain control) after training GPs on pain management.Of three studies on shoulder pain, one study reported that there may be little or no improvement in patient outcomes (functional capacity) after GP education on shoulder pain and injection training.Of two studies on other musculoskeletal conditions, one study on pain management showed that there may be worse patient outcomes (pain control) after GP training on the use of validated assessment scales.The 12 remaining studies across all musculoskeletal conditions showed little or no improvement in GP behaviour and patient outcomes.The direction of the targeted behaviour (i.e. increasing or decreasing a behaviour) does not seem to affect the effectiveness of an intervention. The majority of the studies did not investigate the potential adverse effects of the interventions and only three studies included a cost-effectiveness analysis.Overall, there were important methodological limitations in the body of evidence, with just a third of the studies reporting adequate allocation concealment and blinded outcome assessments. While our confidence in the pooled effect estimate of interventions for improving diagnostic testing and medication prescribing in osteoporosis is high, our confidence in the reported effect estimates in the remaining studies is low. AUTHORS' CONCLUSIONS There is good-quality evidence that a GP alerting system with or without patient-directed education on osteoporosis improves guideline-consistent GP behaviour, resulting in better diagnosis and treatment rates.Interventions such as GP reminder messages and GP feedback on performance combined with guideline dissemination may lead to small improvements in guideline-consistent GP behaviour with regard to low back pain, while GP education on osteoarthritis pain and the use of educationally influential physicians may lead to slight improvement in patient outcomes and guideline-consistent behaviour respectively. However, further studies are needed to ascertain the effectiveness of such interventions in improving GP behaviour and patient outcomes.
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Affiliation(s)
- Victoria Tzortziou Brown
- Blizard Institute, Barts and The London School of Medicine and Dentistry.Centre for Primary Care and Public HealthLondonUK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Sports and Exercise Medicine, William Harvey Research Institute,LondonUKE1 4DG
| | - Martin Underwood
- Warwick Medical SchoolWarwick Clinical Trials UnitCoventryWarwickshireUKCV4 7AL
| | | | - Olwyn Westwood
- Warwick Medical School, The University of WarwickGibbet Hall CampusCoventryUKCV4 7AL
| | - Dylan Morrissey
- Queen Mary University of LondonSport and Exercise MedicineLondonUK
- Barts Health NHS TrustPhysiotherapy DepartmentLondonUK
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Woong Jin H, L. Doolen T. A comparison of Korean and US continuous improvement projects. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2014. [DOI: 10.1108/ijppm-01-2013-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Quality Circles and Kaizen Events have resulted in productivity and quality improvements for organizations. There is limited empirical research comparing these two approaches. This research study was designed to understand the similarities and differences in the structure and outcomes of these two popular continuous improvement approaches in Korea and the USA. The paper aims to discuss these issues.
Design/methodology/approach
– A logic model was used to structure a comparative analysis of Quality Circles and Kaizen Events undertaken in six different organizations in Korea and the USA. A logic model framework consisting of four areas (resources, activities, outputs and outcomes) was used to assess the key components of these six improvement projects. Data for three different comparative case study project pairs were collected. Projects were matched on both manufacturer-level and project-level characteristics. Matched projects were similar in size and type of product produced.
Findings
– Similarities between Quality Circles and Kaizen Events were identified in every component of the logic model. Both mechanisms were effective in driving improvements in performance and in motivating employees, even though significant differences in the project size, type, and industrial sector existed across the six different projects.
Originality/value
– There was no evidence to support the conclusion that one continuous improvement approach is more or less effective than the other. Both approaches produced improvements in both technical and social system outcomes. Overall, it appears based on this study, that both Quality Circles and Kaizen Events can be successfully deployed in an organization's continuous improvement journey.
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Nadler M, Alibhai S, Catton P, Catton C, To MJ, Jones JM. Osteoporosis knowledge, health beliefs, and healthy bone behaviours in patients on androgen-deprivation therapy (ADT) for prostate cancer. BJU Int 2013; 111:1301-9. [PMID: 23351062 DOI: 10.1111/j.1464-410x.2012.11777.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To describe in patients with prostate cancer, receiving androgen-deprivation therapy (ADT): (i) knowledge, self-efficacy (SE), and health beliefs about osteoporosis (OP); (ii) current engagement in healthy bone behaviours (HBBs). To explore the relationships between knowledge, SE, and health beliefs, and engagement in HBBs. PATIENTS AND METHODS 175 patients receiving ADT by injection completed questionnaires assessing current HBBs, OP knowledge, SE, and health beliefs (motivation, perceived susceptibility, and seriousness). Descriptive statistics and independent samples t-tests were used to assess relationships between knowledge, SE, health beliefs, and engagement in HBBs. RESULTS Only 38% of patients had undergone a dual X-ray absorptiometry scan in the past 2 years. OP knowledge was low (mean [sd, range] 9.6 [4.4, 0-19]) and perceived SE moderate (84.7 [24.5, 0-120]). Health motivation was fairly high (23.6 [3.1, 6-30]), but perceived susceptibility (16.8 [4.3]) and seriousness (16.8 [4.2]) of OP were low. Few patients met the recommendations for vitamin D intake (42%) and exercise (31%), and 15% were at risk of over-supplementation of calcium. Patients taking calcium supplements (P = 0.04), and meeting guidelines for vitamin D (P = 0.008) and for exercise (P = 0.002) had significantly greater knowledge than those who did not. Patients who were engaging in less than four of five HBBs had lower knowledge (P < 0.001) and health motivation (P = 0.01) than those who were engaging in four or all five HBBs. CONCLUSIONS Most patients who are receiving ADT are not receiving appropriate screening, lack basic information about bone health, and are not engaging in the appropriate HBBs. These findings support the application of the Health Belief Model in this population: interventions that teach patients about the implications of bone loss, encourage proper uptake of HBBs, and promote feelings of SE could increase engagement in HBBs to prevent and manage bone loss.
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Affiliation(s)
- Michelle Nadler
- Cancer Survivorship Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implement Sci 2012; 7:48. [PMID: 22624776 PMCID: PMC3533817 DOI: 10.1186/1748-5908-7-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
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Affiliation(s)
- Courtney C Kennedy
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Richard G Crilly
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Robert G Josse
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Laura E Pickard
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Susanne King
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Mary-Lou van der Horst
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Glenda Campbell
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Anna M Sawka
- Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada
| | - Lynn Nash
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
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The current practice of screening, prevention, and treatment of androgen-deprivation-therapy induced osteoporosis in patients with prostate cancer. JOURNAL OF ONCOLOGY 2012; 2012:958596. [PMID: 22619678 PMCID: PMC3350851 DOI: 10.1155/2012/958596] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/14/2012] [Indexed: 11/17/2022]
Abstract
Introduction. ADT is used in the management of locally advanced and metastatic disease. The detrimental effect of ADT on bone density is well documented. This study assesses care gaps in screening, prevention and treatment of osteoporosis among prostate cancer patients. Methods. We conducted a retrospective cohort study for patients diagnosed with non-metastatic prostate cancer on ADT. Charts from a tertiary oncology center were assessed for utilization of DXA scan, prescription of calcium, vitamin D, calcitonin and bisphosphonates.Bivariate analysis was used to determine the effect of patient characteristics and likelihood for osteoporosis screening. Results. 149 charts were reviewed, with 3-year mean follow-up. 58.8% of men received a baseline DXA, of which 20.3% had a repeat DXA within their follow-up periods.In all, 28% were appropriately screened and managed for osteoporosis (received repeat DXA, bisphosphonate). In bivariate analysis, the number of ADT injections which correlate with the duration of androgen suppression was significantly associated with the number of DXA scans. Conclusions. Our study found a care gap in the screening, prevention, and treatment of osteoporosis in this population. Patients receiving the most ADT injections were more likely to be screened. Our results suggest healthcare providers treating prostate cancer are insufficiently screening and treating this susceptible population. We suggest baseline measurement of BMD at the initiation of ADT with periodic reassessment during therapy.
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Martínez Pérez JA, Palacios S, García FC, Pérez M. Assessing osteoporosis risk factors in Spanish menopausal women. Gynecol Endocrinol 2011; 27:807-13. [PMID: 21190416 DOI: 10.3109/09513590.2010.540599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES (1) To assess the prevalence of osteoporosis risk factors in Spanish menopausal women; (2) to detect medical and lifestyle risk factor differences between perimenopausal and postmenopausal women; (3) and to identify the main factors responsible for osteoporosis. METHODS Cross-sectional descriptive study encompassing women aged 45-65 across Spain. The study population sample was collected through random sampling and a total of 10,514 women were included. Socio-demographic, medical history, and lifestyle data were assessed. RESULTS The prevalence of osteoporosis risk factors was 67.6%. The most common risk factors were physical inactivity (53.6%), use of medication related to osteoporosis risk (45.9%), and low calcium intake (30.1%). There were statistically significant differences between peri- and postmenopausal women in terms of smoking status, alcohol intake, personal history, poor dairy product intake, and medication use that could increase risk. Logistic regression analysis showed that osteoporosis was significantly associated with age, family history, age at onset of menopause, Kupperman Index, prolonged immobilization, weight loss, and other diseases that increase the probability of developing osteoporosis. CONCLUSIONS A high prevalence of women taking osteoporosis risk-related medication was observed in our study. There was correlation between the menopausal symptoms' degree of severity and the risk of suffering from osteoporosis.
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Lau AN, Ioannidis G, Potts Y, Giangregorio LM, Van der Horst ML, Adachi JD, Papaioannou A. What are the beliefs, attitudes and practices of front-line staff in long-term care (LTC) facilities related to osteoporosis awareness, management and fracture prevention? BMC Geriatr 2010; 10:73. [PMID: 20929589 PMCID: PMC2958961 DOI: 10.1186/1471-2318-10-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 10/08/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Compared to the general elderly population, those institutionalized in LTC facilities have the highest prevalence of osteoporosis and subsequently have higher incidences of vertebral and hip fractures. The goal of this study is to determine how well nurses at LTC facilities are educated to properly administer bisphosphonates. A secondary question assessed was the nurse's and PSW's attitudes and beliefs regarding the role and benefits of vitamin D for LTC patients. METHODS Eight LTC facilities in Hamilton were surveyed, and all nurses were offered a survey. A total 57 registered nurses were surveyed. A 21 item questionnaire was developed to assess existing management practices and specific osteoporosis knowledge areas. RESULTS The questionnaire assessed the nurse's and personal support worker's (PSWs) education on how to properly administer bisphosphonates by having them select all applicable responses from a list of options. These options included administering the drug before, after or with meals, given with or separate from other medications, given with juice, given with or without water, given with the patient sitting up, or finally given with the patient supine. Only 52% of the nurses and 8.7% of PSWs administered the drug properly, where they selected the options: (given before meals, given with water, given separate from all other medications, and given in a sitting up position). If at least one incorrect option was selected, then it was scored as an inappropriate administration. Bisphosphonates were given before meals by 85% of nurses, given with water by 90%, given separately from other medication by 71%, and was administered in an upright position by 79%. Only 52% of the nurses and 8.7% of PSWs surveyed were administering the drug properly. Regarding the secondary question, of the 57 nurses surveyed, 68% strongly felt their patients should be prescribed vitamin D supplements. Of the 124 PSWs who completed the survey, 44.4% strongly felt their patients should be prescribed vitamin D supplementation. CONCLUSION Bisphosphonates are quite effective in increasing the bone mineral density of LTC patients, and may reduce fracture rates, but it is only effective if properly administered. In our study, proper administration of bisphosphonate therapy was less than optimal. In summary, although the education of health providers has improved since the mid-1990's, this area still requires further attention and the subject of future quality assurance research.
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Affiliation(s)
- Arthur N Lau
- Division of Rheumatology and Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
| | - George Ioannidis
- Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yelena Potts
- St Joseph's Healthcare, Hamilton, Ontario, Canada
| | | | - Mary-Lou Van der Horst
- Division of Geriatrics and Department of Medicine, Hamilton Health Science and McMaster University, Hamilton, Ontario, CIHR -Eli Lilly Chair Osteoporosis and Fracture Prevention, Canada
| | - Jonathan D Adachi
- Division of Rheumatology and Department of Medicine, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Papaioannou
- Division of Geriatrics and Department of Medicine, Hamilton Health Science and McMaster University, Hamilton, Ontario, CIHR -Eli Lilly Chair Osteoporosis and Fracture Prevention, Canada
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Laliberté MC, Perreault S, Dragomir A, Goudreau J, Rodrigues I, Blais L, Damestoy N, Corbeil D, Lalonde L. Impact of a primary care physician workshop on osteoporosis medical practices. Osteoporos Int 2010; 21:1471-85. [PMID: 19937428 DOI: 10.1007/s00198-009-1116-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 09/22/2009] [Indexed: 01/06/2023]
Abstract
SUMMARY Attendance at a fragility-fractures-prevention workshop by primary care physicians was associated with higher rates of osteoporosis screening and treatment initiation in elderly female patients and higher rates of treatment initiation in high-risk male and female patients. However, osteoporosis management remained sub-optimal, particularly in men. INTRODUCTION Rates of osteoporosis-related medical practices of primary care physicians exposed to a fragility-fractures-prevention workshop were compared with those of unexposed physicians. METHODS In a cluster cohort study, 26 physicians exposed to a workshop were matched with 260 unexposed physicians by sex and year of graduation. For each physician, rates of bone mineral density (BMD) testing and osteoporosis treatment initiation among his/her elderly patients 1 year following the workshop were computed. Rates were compared using multilevel logistic regression models controlling for potential patient- and physician-level confounders. RESULTS Twenty-five exposed physicians (1,124 patients) and 209 unexposed physicians (9,663 patients) followed at least one eligible patient. In women, followed by exposed physicians, higher rates of BMD testing [8.5% versus 4.2%, adjusted OR (aOR) = 2.81, 95% CI 1.60-4.94] and treatment initiation with bone-specific drugs (BSDs; 4.8% vs. 2.4%, aOR = 1.95, 1.06-3.60) were observed. In men, no differences were detected. In patients on long-term glucocorticoid therapy or with a previous osteoporotic fracture, higher rates of treatment initiation with BSDs were observed in women (12.0% vs. 1.9%, aOR = 7.38, 1.55-35.26), and men were more likely to initiate calcium/vitamin D (5.3% vs. 0.8%, aOR = 7.14, 1.16-44.06). CONCLUSIONS Attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices for elderly women and high-risk men and women. However, osteoporosis detection and treatment remained sub-optimal, particularly in men.
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Affiliation(s)
- M-C Laliberté
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada
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Ioannidis G, Papaioannou A, Thabane L, Gafni A, Hodsman A, Kvern B, Walsh A, Jiwa F, Adachi JD. The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC). BMC MEDICAL EDUCATION 2009; 9:54. [PMID: 19660103 PMCID: PMC2731752 DOI: 10.1186/1472-6920-9-54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 08/06/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Osteoporosis is a serious but treatable condition. However, appropriate therapy utilization of the disease remains suboptimal. Thus, the objective of the study was to change physicians' therapy administration behavior in accordance with the Osteoporosis Canada 2002 guidelines. METHODS The Project was a two year cohort study that consisted of five Quality Circle (QC) phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 family physicians formed 34 QCs and participated in the study. Physicians evaluated a total of 8376, 7354 and 3673 randomly selected patient charts at baseline, follow-up #1 and the final follow-up, respectively. Patients were divided into three groups; the high-risk, low-risk, and low-risk without fracture groups. The generalized estimating equations technique was utilized to model the change over time of whether physicians RESULTS The odds of appropriate therapy was 1.29 (95% CI: 1.13, 1.46), and 1.41 (95% CI: 1.20, 1.66) in the high risk group, 1.15 (95% CI: 0.97, 1.36), and 1.16 (95% CI: 0.93, 1.44) in the low risk group, and 1.20 (95% CI: 1.01, 1.43), and 1.23 (95% CI: 0.97, 1.55) in the low risk group without fractures at follow-up #1 and the final follow-up, respectively. CONCLUSION QCs methodology was successful in increasing physicians' appropriate use of osteoporosis medications in accordance with Osteoporosis Canada guidelines.
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Affiliation(s)
| | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
- Director of Biostatistics, Father Sean O'Sullivan Research Centre and Centre for Evaluation of Medicines, St Joseph's Healthcare, Hamilton, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Anthony Hodsman
- Department of Medicine, University of Western Ontario, London, Canada
| | - Brent Kvern
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
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Teng GG, Curtis JR, Saag KG. Quality health care gaps in osteoporosis: how can patients, providers, and the health system do a better job? Curr Osteoporos Rep 2009; 7:27-34. [PMID: 19239827 DOI: 10.1007/s11914-009-0006-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A significant gap exists between evidence-based advances and real-world clinical practice in the diagnosis and prevention of osteoporosis. The goal of osteoporosis care is to prevent fractures and improve health-related quality of life, and ideally lower mortality. Despite recent advances in osteoporosis detection and treatment options, studies suggest underdiagnosis and undertreatment of osteoporosis, even among those who have already sustained fractures. The challenges in translating knowledge into practice are multifaceted, with efforts directed at the patient, provider, and health care system levels achieving variable success at the population level. Methods to improve quality of care in osteoporosis need to be multipronged, with emphasis on clinical process improvement and reliance on interdisciplinary teams. We review the growing literature on quality of care for osteoporosis.
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Affiliation(s)
- Gim Gee Teng
- Center for Education and Research on Therapeutics of Musculoskeletal Disorders, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35294-3708, USA
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