1
|
Nawaz HA, Alqusibri A. Motivation and Barriers for Seeking Osteoporosis Screening Services Among the Elderly Population in Al-Madina Munawara. Cureus 2024; 16:e63225. [PMID: 39070513 PMCID: PMC11281041 DOI: 10.7759/cureus.63225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Osteoporosis is a chronic bone disease associated with a reduction in bone mass and an increased risk of fractures. The prevalence of osteoporosis is rising globally, including in Saudi Arabia, where there is a lack of information regarding the uptake of osteoporosis screening services. This study aims to examine self-efficacy and barriers toward osteoporosis screening in older women and men in Al-Madina Munawara, Saudi Arabia. Methods A cross-sectional study was conducted among adults aged 60 and above who attended primary healthcare centers. Convenience sampling was used to recruit participants, and a self-administered questionnaire was used to assess sociodemographic characteristics, osteoporosis status, general health-related characteristics, and screening self-efficacy. Analyses included multivariable regression analyses to evaluate the association between osteoporosis screening self-efficacy and potential explanatory variables. Data were collected in the last quarter of 2023. Results In a study involving 342 completed questionnaires, the mean age of participants was 66.2 years (SD = 4.3), with a range from 60 to 79 years, and the majority were male (230, 67.3%), having chronic diseases (226, 66.3%). Regarding osteoporosis risk factors and screening behaviors, the majority did not use prednisolone (252, 74.1%), did not have a family history of osteoporosis (216, 63.2%), had not experienced falls in the past five years (223, 65.2%), and had not undergone osteoporosis screening (299, 87.4%). The mean self-efficacy score for osteoporosis screening was 37.7 (SD = 4.7), ranging from 10 to 50, which indicated a moderate level of screening self-efficacy. In multivariate analysis, smokers were more likely to have higher scores in self-efficacy for osteoporosis screening compared to non-smokers (RR = 1.10; 95% CI = 1.01, 1.21). Participants who did osteoporosis screening (RR = 1.12; 95% CI = 1.01, 1.24) and those who were planning to do osteoporosis screening (RR = 1.10; 95% CI = 1.03, 1.19) were more likely to have higher score in self-efficacy for osteoporosis screening compared to their counterparts. Conclusion The participants had a fair level of screening self-efficacy. The smokers and those who had undergone or planned to undertake osteoporosis screening demonstrated higher self-efficacy scores than others. A lot of progress could be made in decreasing the burden of osteoporosis and enhancing the overall health and well-being of the older population by addressing these issues using specific interventions and policy measures.
Collapse
Affiliation(s)
- Heba A Nawaz
- Madinah Health Cluster, Saudi Ministry of Health, Madinah, SAU
| | - Asmaa Alqusibri
- Madinah Health Cluster, Saudi Ministry of Health, Madinah, SAU
| |
Collapse
|
2
|
Hampson G, Stone M, Lindsay JR, Crowley RK, Ralston SH. Diagnosis and Management of Osteoporosis During COVID-19: Systematic Review and Practical Guidance. Calcif Tissue Int 2021; 109:351-362. [PMID: 34003337 PMCID: PMC8129963 DOI: 10.1007/s00223-021-00858-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
It is acknowledged that the COVID-19 pandemic has caused profound disruption to the delivery of healthcare services globally. This has affected the management of many long-term conditions including osteoporosis as resources are diverted to cover urgent care. Osteoporosis is a public health concern worldwide and treatment is required for the prevention of further bone loss, deterioration of skeletal micro-architecture, and fragility fractures. This review provides information on how the COVID-19 pandemic has impacted the diagnosis and management of osteoporosis. We also provide clinical recommendations on the adaptation of care pathways based on experience from five referral centres to ensure that patients with osteoporosis are still treated and to reduce the risk of fractures both for the individual patient and on a societal basis. We address the use of the FRAX tool for risk stratification and initiation of osteoporosis treatment and discuss the potential adaptations to treatment pathways in view of limitations on the availability of DXA. We focus on the issues surrounding initiation and maintenance of treatment for patients on parenteral therapies such as zoledronate, denosumab, teriparatide, and romosozumab during the pandemic. The design of these innovative care pathways for the management of patients with osteoporosis may also provide a platform for future improvement to osteoporosis services when routine clinical care resumes.
Collapse
Affiliation(s)
- G Hampson
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, Lambeth Palace Road, 5th Floor, North Wing, London, SE1 7EH, UK.
- Department of Rheumatology, Metabolic Bone Clinic, Guy's Hospital, London, UK.
| | - M Stone
- Metabolic Bone Service, University Hospital Llandough, Llandough, Penarth, CF64 2XX, UK
| | - J R Lindsay
- Osteoporosis and Bone Metabolism Service, Musgrave Park Hospital, Belfast, Northern Ireland, UK
| | - R K Crowley
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - S H Ralston
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
- Rheumatic Diseases Unit, NHS Lothian Western General Hospital Edinburgh, Edinburgh, EH4 2XU, UK
| |
Collapse
|
3
|
Paskins Z, Crawford-Manning F, Bullock L, Jinks C. Identifying and managing osteoporosis before and after COVID-19: rise of the remote consultation? Osteoporos Int 2020; 31:1629-1632. [PMID: 32548787 PMCID: PMC7297512 DOI: 10.1007/s00198-020-05465-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/19/2023]
Abstract
UNLABELLED The COVID-19 pandemic is influencing methods of healthcare delivery. In this short review, we discuss the evidence for remote healthcare delivery in the context of osteoporosis. INTRODUCTION The COVID-19 pandemic has undoubtedly had, and will continue to have, a significant impact on the lives of people living with, and at risk of, osteoporosis and those caring for them. With osteoporosis outpatient and Fracture Liaison Services on pause, healthcare organisations have already moved to delivering new and follow-up consultations remotely, where staffing permits, by telephone or video. METHODS In this review, we consider different models of remote care delivery, the evidence for their use, and the possible implications of COVID-19 on osteoporosis services. RESULTS Telemedicine is a global term used to describe any use of telecommunication systems to deliver healthcare from a distance and encompasses a range of different scenarios from remote clinical data transfer to remote clinician-patient interactions. Across a range of conditions and contexts, there remains unclear evidence on the acceptability of telemedicine and the effect on healthcare costs. Within the context of osteoporosis management, there is some limited evidence to suggest telemedicine approaches are acceptable to patients but unclear evidence on whether telemedicine approaches support informed drug adherence. Gaps in the evidence pertain to the acceptability and benefits of using telemedicine in populations with hearing, cognitive, or visual impairments and in those with limited health literacy. CONCLUSION There is an urgent need for further health service evaluation and research to address the impact of remote healthcare delivery during COVID-19 outbreak on patient care, and in the longer term, to identify acceptability and cost- and clinical-effectiveness of remote care delivery on outcomes of relevance to people living with osteoporosis.
Collapse
Affiliation(s)
- Z Paskins
- School of Primary, Community and Social Care, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK.
| | - F Crawford-Manning
- School of Primary, Community and Social Care, Keele University & Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - L Bullock
- School of Primary, Community and Social Care, Keele University, Newcastle-under-Lyme, UK
| | - C Jinks
- School of Primary, Community and Social Care, Keele University, Newcastle-under-Lyme, UK
| |
Collapse
|
4
|
Gai QY, Lv H, Li YP, Fu QM, Li P. Education intervention for older adults with osteoporosis: a systematic review. Osteoporos Int 2020; 31:625-635. [PMID: 31828364 DOI: 10.1007/s00198-019-05166-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Various education interventions were developed for preventing or managing OP, but the effects of those interventions on older adults were inconclusive. PURPOSE This study evaluated the effectiveness of educational interventions in preventing osteoporosis in older adults. A literature search was performed in MEDLINE (PubMed), Cochrane Library, and CBM (China BioMed Database) from the initial date of each database to Oct 2016. DATA EXTRACTION Two investigators independently extracted essential data from qualified studies concerning the settings, population, interventions, follow-ups, and outcomes of interest, namely effects of bone mineral density tests, changes in behavior, knowledge increase, self-efficacy, medication adherence (calcium and vitamin D), and quality of life, respectively. DATA SYNTHESIS A total of 17 studies met the inclusion criteria and therefore were included in the current study. The overall quality of the included studies was moderate. We were unable to carry out a meta-analysis due to the heterogeneity of these studies. We fond that compared with control groups, patients' knowledge of osteoporosis increased significantly (p < .05) through all five interventions, which included PowerPoint presentations and discussion, class-based educational programs, osteoporosis self-management courses, revised health belief model and classes, computerized support programs and brush-up courses. LIMITATION Studies included in the present study were all conducted in Western countries and only descriptive methods were applied in synthesis due to heterogeneity in interventions and outcomes. CONCLUSION Education interventions were effective in preventing osteoporosis in older adults. Future research should focus on approaching this issue quantitatively (i.e., through meta-analysis).
Collapse
Affiliation(s)
- Q Y Gai
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - H Lv
- Department of Psychology, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Y P Li
- Evidence-based Social Science & Health Research Center, Public Affair School, Nanjing University of Science & Technology, Jiangsu, China
| | - Q M Fu
- Nursing Department, Nanjing Gulou Hospital,The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China.
| | - P Li
- Head nurse of Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China.
| |
Collapse
|
5
|
Kelly A, Crimston-Smith L, Tong A, Bartlett SJ, Bekker CL, Christensen R, De Vera MA, de Wit M, Evans V, Gill M, March L, Manera K, Nieuwlaat R, Salmasi S, Scholte-Voshaar M, Singh JA, Sumpton D, Toupin-April K, Tugwell P, van den Bemt B, Verstappen S, Tymms K. Scope of Outcomes in Trials and Observational Studies of Interventions Targeting Medication Adherence in Rheumatic Conditions: A Systematic Review. J Rheumatol 2019; 47:1565-1574. [PMID: 31839595 DOI: 10.3899/jrheum.190726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Nonadherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. METHODS We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with prespecified extraction and analysis protocols. RESULTS Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains), and adherence-related factors (e.g., medication knowledge; 32 domains). We subdivided adherence into 3 phases: initiation (n = 13 studies, 25%), implementation (n = 32, 60%), persistence (n = 27, 51%), and phase unclear (n = 20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric, and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were medication adverse events (n = 24, 45%), disease activity (n = 11, 21%), bone turnover markers/physical function/quality of life (each n = 10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were medication beliefs (n = 8, 15%), illness perception/medication satisfaction/satisfaction with medication information (each n = 5, 9%), condition knowledge/medication knowledge/trust in doctor (each n = 3, 6%). CONCLUSION The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.
Collapse
Affiliation(s)
- Ayano Kelly
- A. Kelly, Clinical Associate Lecturer, Australian National University, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia;
| | - Luke Crimston-Smith
- L. Crimston-Smith, BN, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, Australia
| | - Allison Tong
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Susan J Bartlett
- S.J. Bartlett, PhD, Professor, Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Quebec, Canada, and Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charlotte L Bekker
- C.L. Bekker, PhD, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robin Christensen
- R. Christensen, PhD, Professor of Biostatistics and Clinical Epidemiology, Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen University Hospital, Copenhagen, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Mary A De Vera
- M.A. De Vera, PhD, Assistant Professor, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Maarten de Wit
- M. de Wit, PhD, OMERACT Patient Research Partner, the Netherlands
| | - Vicki Evans
- V. Evans, PhD, Clear Vision Consulting, Canberra, and OMERACT Patient Research Partner, and Discipline of Optometry, University of Canberra, Canberra, Australia
| | - Michael Gill
- M. Gill, BA, Dragon Claw, Sydney, Australia, and OMERACT Patient Research Partner
| | - Lyn March
- L. March, PhD, Professor, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and Department of Rheumatology, Royal North Shore Hospital, and Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Karine Manera
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Robby Nieuwlaat
- R. Nieuwlaat, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shahrzad Salmasi
- S. Salmasi, MSc, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Marieke Scholte-Voshaar
- M. Scholte-Voshaar, MSc, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands and OMERACT Patient Research Partner
| | - Jasvinder A Singh
- J.A. Singh, Professor, MD, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama, and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Karine Toupin-April
- K. Toupin-April, PhD, Associate Scientist, Children's Hospital of Eastern Ontario Research Institute, and Assistant Professor, Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bart van den Bemt
- B. van den Bemt, PhD, Assistant Professor, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, and Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Suzanne Verstappen
- S. Verstappen, PhD, Reader, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, Associate Professor, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, Canberra Hospital, Canberra, Australia
| |
Collapse
|
6
|
Beauvais C, Poivret D, Lespessailles E, Thevenot C, Aubraye D, Euller Ziegler L, Beranger M, Filaire E, Gendarme S, Legrand K, Magar Y, Rousière M, Lévy-Weil F, Cortet B, Rat AC. Understanding Patients' Perspectives and Educational Needs by Type of Osteoporosis in Men and Women and People with Glucocorticosteroid-Induced Osteoporosis: A Qualitative Study to Improve Disease Management. Calcif Tissue Int 2019; 105:589-608. [PMID: 31506706 DOI: 10.1007/s00223-019-00607-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/22/2019] [Indexed: 01/18/2023]
Abstract
The aim of the study was to investigate similarities and differences in health beliefs, experiences and educational needs by type of osteoporosis (OP), particularly in people with glucocorticoid-induced OP (GIOP) and men. A qualitative study was conducted via focus groups involving post-menopausal women with or without osteoporotic fractures, osteoporotic men and people with GIOP. Fifty-three participants were included in eight groups. A wide range of health beliefs was found for all types of OP. Osteoporosis was considered a natural consequence of ageing except in men or conversely a serious disease associated with risk of new fractures and disability. GIOP patients had heterogeneous knowledge of OP and reported fewer prevention behaviours, and their quality of life was affected by the causal illness. Men had difficulties coping with the loss of their functional abilities and felt that OP was a "women's" disease. Beliefs about treatments ranged from confidence to fear of adverse effects or doubt about efficacy in all types of OP. Participants were interested in physical activity, fall prevention and diet, and preferred group sessions. GIOP patients and men had an interest in face-to-face education. Men were also interested in brief information including via the Internet. Patients' beliefs about OP differed by type of OP. Specific populations such as men or people with GIOP need particular care owing to experiences and needs. Offering group sessions in educational interventions is of interest to allow for sharing experiences and also face-to-face education for men and GIOP patients or the Internet for men.
Collapse
Affiliation(s)
- Catherine Beauvais
- Rheumatology Department, Hôpital Universitaire Saint Antoine, APHP, Paris, France.
| | - Didier Poivret
- Rheumatology Department, Centre Hospitalier régional Metz-Thionville, Thionville, France
| | - Eric Lespessailles
- Rheumatology Department, Centre Hospitalier Régional, Orléans La Source, France
| | | | - Dominique Aubraye
- Rheumatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | | | - Martine Beranger
- Rheumatology Department, Centre Hospitalier Régional, Orléans La Source, France
| | - Edith Filaire
- CIAMS, Universite Paris Sud, Université Paris-Saclay, Orsay Cedex, France
- CIAMS, Université d'Orleans, Orleans, France
- INRA, UNH, Unite de Nutrition Humaine, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sophie Gendarme
- Centre Hospitalier régional Universitaire de Nancy, INSERM, CIC Epidémiologie clinique, Nancy, France
| | - Karine Legrand
- Centre Hospitalier régional Universitaire de Nancy, INSERM, CIC Epidémiologie clinique, Nancy, France
| | | | - Mickael Rousière
- Rheumatology Department, Hôpital Universitaire Saint Antoine, APHP, Paris, France
| | - Florence Lévy-Weil
- Rheumatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Bernard Cortet
- Centre Hospitalier Universitaire C.H.U. Lille and Université Lille 2, Rheumatology Department and EA 4490, 59000, Lille, France
| | - Anne Christine Rat
- Université de Lorraine, APEMAC, 54000, Nancy, France
- CHU Caen Rheumatology Department, INSERM, CHRU Nancy, CIC 1433 Epidémiologie clinique, Caen, France
| | | |
Collapse
|
7
|
Farzandipour M, Nabovati E, Anvari S, Vahedpoor Z, Sharif R. Phone-based interventions to control gestational weight gain: a systematic review on features and effects. Inform Health Soc Care 2018; 45:15-30. [DOI: 10.1080/17538157.2018.1540421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Vahedpoor
- Department of Gynecology and Obstetrics, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
8
|
van den Berg P, van Haard PMM, van der Veer E, Geusens PP, van den Bergh JP, Schweitzer DH. A dedicated Fracture Liaison Service telephone program and use of bone turnover markers for evaluating 1-year persistence with oral bisphosphonates. Osteoporos Int 2018; 29:813-824. [PMID: 29260291 DOI: 10.1007/s00198-017-4340-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/04/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED Telephone call intervention did not improve alendronate persistence in Fracture Liaison Service (FLS) patients in this study. A bone turnover marker cut-off point for alendronate persistence is proposed for individual FLS patients. INTRODUCTION FLS aims to prevent subsequent fractures, which should include improving patients' persistence with prescribed oral bisphosphonates. We studied the influence of telephone calls and the predictive value of changes in bone turnover markers (BTMs) for evaluating persistence with alendronate. METHODS Postmenopausal women with a recent fracture and osteoporosis who started alendronate were randomized to receive three phone calls (PC) (after 1, 4, and 12 months) or no phone calls (no PC). s-CTX and P1NP were measured at baseline and after 3, 6, 9, and 12 months. As a reference group, 30 postmenopausal osteopenic patients with a recent fracture were analyzed as well. Persistence was assessed using the Dutch National Switch Point Pharmacies-GPs database and cross-referenced with PC, no PC, and BTM changes. Cut-off values of BTMs were calculated based on least significant change (LSC) and also on underrunning median values of the untreated osteopenic postmenopausal reference group with a recent fracture. RESULTS Out of 119 patients, 93 (78%) completed 12 months follow-up (45 PC and 48 no PC). Mean age was 69 years. Persistence was similar in PC and no PC participants. The cut-off value > 29% (< 415 ng/L) as LSC of s-CTX and > 36% (< 53.1 μg/L) as LSC of P1NP was determined optimally showing alendronate persistence after 1 year (being 93 and 88%, respectively). CONCLUSIONS In this context, telephone calls did not improve persistence. In around 90% of patients, 1-year alendronate persistence was confirmed by achieving LSC of s-CTX and of P1NP at 12 months.
Collapse
Affiliation(s)
- P van den Berg
- Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | - P M M van Haard
- Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Gasthuis, Delft, the Netherlands
| | - E van der Veer
- Laboratory Medicine, University Medical Centre, Groningen, the Netherlands
| | - P P Geusens
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Hasselt University, Hasselt, Belgium
| | - J P van den Bergh
- Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg, Maastricht University Medical Center, Maastricht, the Netherlands
| | - D H Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, the Netherlands
| |
Collapse
|
9
|
Morfeld JC, Vennedey V, Müller D, Pieper D, Stock S. Patient education in osteoporosis prevention: a systematic review focusing on methodological quality of randomised controlled trials. Osteoporos Int 2017; 28:1779-1803. [PMID: 28236127 DOI: 10.1007/s00198-017-3946-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/26/2017] [Indexed: 01/23/2023]
Abstract
UNLABELLED This review summarizes evidence regarding the effects of patient education in osteoporosis prevention and treatment. The included studies reveal mixed results on a variety of endpoints. Methodological improvem ent of future RCTs (e.g. with regard to randomization and duration of follow-up) might yield more conclusive evidence on the effects of patient education in osteoporosis INTRODUCTION: This review aims to evaluate the effects of patient education on osteoporosis prevention and treatment results. METHODS Multiple databases including PubMed and Embase were searched until February 2016. Randomised controlled trials (RCTs) were eligible if they included adults diagnosed with or at risk of osteoporosis and assessed patient education interventions (group- or individual-based). Outcomes regarding osteoporosis management including initiation of and adherence to pharmacological therapy, physical activity, calcium and vitamin D intake, changes in smoking behaviour, fractures, quality of life (QoL) and osteoporosis knowledge were evaluated. The Cochrane collaboration's tool for assessing the risk of bias was used to assess the internal validity of included trials. RESULTS Fifteen articles (13 different studies) published between 2001 and 2013 were included (group-based education = 7, individual-based education = 5, both = 1). The general risk of bias was considered as moderate to high. The effects on 'bone mineral density (BMD) testing and/or pharmacological therapy' (composite endpoint), 'calcium intake' and 'vitamin D intake' as well as 'osteoporosis knowledge' were statistically significant in favour of the intervention in ≥50% of the studies analysing these outcomes. Differences between the intervention and the control group regarding 'pharmacological therapy', 'medication adherence', 'physical activity', 'fractures' and 'QoL' were found to be statistically significant in <50% of the trials. CONCLUSIONS This review indicates that it is still unclear whether patient education is beneficial and whether it has a significant and clinically relevant impact on osteoporosis management results. Educational programmes for osteoporosis require further investigation within the context of well-conducted RCTs.
Collapse
Affiliation(s)
- Jana-Carina Morfeld
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| |
Collapse
|
10
|
Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014; 2014:CD000011. [PMID: 25412402 PMCID: PMC7263418 DOI: 10.1002/14651858.cd000011.pub4] [Citation(s) in RCA: 671] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications. OBJECTIVES The primary objective of this review is to assess the effects of interventions intended to enhance patient adherence to prescribed medications for medical conditions, on both medication adherence and clinical outcomes. SEARCH METHODS We updated searches of The Cochrane Library, including CENTRAL (via http://onlinelibrary.wiley.com/cochranelibrary/search/), MEDLINE, EMBASE, PsycINFO (all via Ovid), CINAHL (via EBSCO), and Sociological Abstracts (via ProQuest) on 11 January 2013 with no language restriction. We also reviewed bibliographies in articles on patient adherence, and contacted authors of relevant original and review articles. SELECTION CRITERIA We included unconfounded RCTs of interventions to improve adherence with prescribed medications, measuring both medication adherence and clinical outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive findings at earlier time points. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data and a third author resolved disagreements. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Pooling results according to one of these characteristics still leaves highly heterogeneous groups, and we could not justify meta-analysis. Instead, we conducted a qualitative analysis with a focus on the RCTs with the lowest risk of bias for study design and the primary clinical outcome. MAIN RESULTS The present update included 109 new RCTs published since the previous update in January 2007, bringing the total number of RCTs to 182; we found five RCTs from the previous update to be ineligible and excluded them. Studies were heterogeneous for patients, medical problems, treatment regimens, adherence interventions, and adherence and clinical outcome measurements, and most had high risk of bias. The main changes in comparison with the previous update include that we now: 1) report a lack of convincing evidence also specifically among the studies with the lowest risk of bias; 2) do not try to classify studies according to intervention type any more, due to the large heterogeneity; 3) make our database available for collaboration on sub-analyses, in acknowledgement of the need to make collective advancement in this difficult field of research. Of all 182 RCTs, 17 had the lowest risk of bias for study design features and their primary clinical outcome, 11 from the present update and six from the previous update. The RCTs at lowest risk of bias generally involved complex interventions with multiple components, trying to overcome barriers to adherence by means of tailored ongoing support from allied health professionals such as pharmacists, who often delivered intense education, counseling (including motivational interviewing or cognitive behavioral therapy by professionals) or daily treatment support (or both), and sometimes additional support from family or peers. Only five of these RCTs reported improvements in both adherence and clinical outcomes, and no common intervention characteristics were apparent. Even the most effective interventions did not lead to large improvements in adherence or clinical outcomes. AUTHORS' CONCLUSIONS Across the body of evidence, effects were inconsistent from study to study, and only a minority of lowest risk of bias RCTs improved both adherence and clinical outcomes. Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. The research in this field needs advances, including improved design of feasible long-term interventions, objective adherence measures, and sufficient study power to detect improvements in patient-important clinical outcomes. By making our comprehensive database available for sharing we hope to contribute to achieving these advances.
Collapse
Affiliation(s)
- Robby Nieuwlaat
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nancy Wilczynski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Tamara Navarro
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nicholas Hobson
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Rebecca Jeffery
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Arun Keepanasseril
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
| | - Thomas Agoritsas
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Niraj Mistry
- St. Michael's HospitalDepartment of Pediatrics30 Bond StreetTorontoONCanadaM5B 1W8
| | - Alfonso Iorio
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Susan Jack
- McMaster UniversitySchool of Nursing, Faculty of Health SciencesHealth Sciences CentreRoom 2J32, 1280 Main Street WestHamiltonONCanadaL8S 4K1
| | | | - Emma Iserman
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Reem A Mustafa
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Dawn Jedraszewski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Chris Cotoi
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - R. Brian Haynes
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
| | | |
Collapse
|
11
|
Pérez-Fernández MR, Almazán Ortega R, Martínez Portela JM, Alves Pérez MT, Segura-Iglesias MC, Pérez-Fernández R. Hábitos saludables y prevención de la osteoporosis en mujeres perimenopáusicas de un ámbito rural. GACETA SANITARIA 2014; 28:163-5. [DOI: 10.1016/j.gaceta.2013.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 10/25/2022]
|
12
|
Marcus JL, Buisker T, Horvath T, Amico KR, Fuchs JD, Buchbinder SP, Grant RM, Liu AY. Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions. HIV Med 2014; 15:385-95. [PMID: 24580813 DOI: 10.1111/hiv.12132] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Adherence is critical for maximizing the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection. Strategies for promoting adherence to HIV treatment, and their potential application to PrEP adherence, have received considerable attention. However, adherence promotion strategies for prevention medications have not been well characterized and may be more applicable to PrEP. We aimed to identify adherence support interventions that have been effective in other prevention fields and could be applied in the HIV prevention context to support pill taking among PrEP users. METHODS To identify adherence support interventions that could be evaluated and applied in the PrEP context, we conducted a systematic review across the following prevention fields: hypertension, latent tuberculosis infection, hyperlipidaemia, oral contraceptives, osteoporosis, malaria prophylaxis, and post-exposure prophylaxis for HIV infection. We included randomized controlled trials that evaluated the efficacy of interventions to improve adherence to daily oral medications prescribed for primary prevention in healthy individuals or for secondary prevention in asymptomatic individuals. RESULTS Our searches identified 585 studies, of which 48 studies met the eligibility criteria and were included in the review; nine evaluated multiple strategies, yielding 64 separately tested interventions. Interventions with the strongest evidence for improving adherence included complex, resource-intensive interventions, which combined multiple adherence support approaches, and low-cost, low-intensity interventions that provided education or telephone calls for adherence support. CONCLUSIONS Our review identified adherence interventions with strong evidence of efficacy across prevention fields and provides recommendations for evaluating these interventions in upcoming PrEP studies.
Collapse
Affiliation(s)
- J L Marcus
- Gladstone Institute of Virology and Immunology, San Francisco, CA, USA; Department of Epidemiology, University of California, Berkeley, CA, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Lai PSM, Chua SS, Chan SP. Pharmaceutical care issues encountered by post-menopausal osteoporotic women prescribed bisphosphonates. J Clin Pharm Ther 2012; 37:536-43. [PMID: 22380577 DOI: 10.1111/j.1365-2710.2012.01335.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pharmacists have been involved in providing comprehensive interventions to osteoporosis patients, but pharmaceutical care issues (PCIs) encountered during such interventions have not been well documented. Therefore, the aim of this study was to document PCIs encountered by post-menopausal osteoporotic women prescribed bisphosphonates. METHODS A randomized controlled study was conducted from September 2005-February 2009 in the University Malaya Medical Centre, Malaysia. This main intervention study measured the effects of pharmaceutical care on medication adherence, persistence, quality of life, knowledge and patient satisfaction. However, this manuscript is part of the main intervention study and focuses only on the PCIs encountered. INCLUSION CRITERIA post-menopausal women diagnosed with osteoporosis (T-score≤-2·5/low-trauma fracture) and prescribed weekly alendronate/risedronate. EXCLUSION CRITERIA those with metabolic bone disease and could not communicate in English. The PCIs identified were collected via personal interviews or telephone calls, and each participant was followed-up for a period of 2 years. All PCIs were discussed with and confirmed by a physician. RESULTS AND DISCUSSION Of the 198 participants recruited, 64 (32·3%) experienced adverse effects because of bisphosphonates whereas one participant (0·5%) refused to start bisphosphonates because of fear of adverse effects. Most adverse effects [50 (74·6%)] were reported during the first 3 months of therapy with gastrointestinal problems being the main issue [23 (11·6%)]. Of the nine participants (4·5%) who discontinued bisphosphonates, only three agreed to take another medication. From the 97 PCIs identified, 77 issues could be classified as drug-related problems [according to the Pharmaceutical Care Network Europe Classification v6·2]. There were 87 causes, 178 interventions and 77 outcomes. The main problem and cause of the PCIs encountered were adverse drug events (83·1% and 74·7% respectively), whereas the main intervention provided was patient counselling (41·0%). All problems were solved (98·5%) except for one because of the lack of cooperation of a patient. After 2 years, 36 participants (20%) were no longer persistent with therapy, 19 (10·6%) did not have clinic follow-up and 53 (26·8%) did not have a bone mineral density scan. WHAT IS NEW AND CONCLUSION The main PCIs identified were related to the use of bisphosphonates and its adverse effects. The study showed that the presence of a clinical pharmacist has enabled patients to voice their medication-related issues and to allow appropriate recommendations and actions to be taken to resolve these issues.
Collapse
Affiliation(s)
- P S M Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | | |
Collapse
|
14
|
White HJ, Bettiol SS, Perera R, Roberts NW, Javaid MK, Farmer AJ. A systematic review assessing the effectiveness of interventions to improve persistence with anti-resorptive therapy in women at high risk of clinical fracture. Fam Pract 2010; 27:593-603. [PMID: 20693238 DOI: 10.1093/fampra/cmq060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND despite availability of effective treatments for osteoporosis, impact on fracture rates may be suboptimal because of failure to adhere to recommended anti-resorptive therapy. OBJECTIVE to identify randomized controlled trials (RCTs) evaluating interventions intended to improve persistence with anti-resorptive therapy for treating women with osteoporosis or osteopenia. The design of the study is a systematic review and meta-analysis of RCTs. METHODS included trials were those reporting interventions to improve persistence with or adherence to anti-resorptive treatment compared to a control medication or usual care. A search of MEDLINE, EMBASE, CINAHL and the Cochrane Library was supplemented by review of cited literature. Reports were reviewed and data pooled where appropriate. The primary outcome was duration of persistence with medication. RESULTS six trials met inclusion criteria, including four reporting persistence as an outcome measure indicating a relative reduction in non-persistence of 22% (pooled relative risk: 0.78, 95% confidence interval 0.65-0.95) for active compared to control interventions. Heterogeneity between the trial effects was present but not significant (I(2) = 47%, P = 0.11). Interventions were varied in design, and some measurements of adherence were subject to self-report bias. Two trials included the majority of participants (3386/3497), accounting for >90% of the weight in the pooled estimate. CONCLUSIONS trials to date suggest potential for improving persistence with medication taking thus improving treatment outcomes and reducing fracture risk. More precise measurement of medication taking and promoting fidelity to a precisely defined intervention protocol may lead to better assessment of impact on clinically important outcomes.
Collapse
Affiliation(s)
- H J White
- University of Oxford Clinical School, John Radcliffe Hospital, Oxford, UK
| | | | | | | | | | | |
Collapse
|
15
|
Lai PSM, Chua SS, Chew YY, Chan SP. Effects of pharmaceutical care on adherence and persistence to bisphosphonates in postmenopausal osteoporotic women. J Clin Pharm Ther 2010; 36:557-67. [PMID: 21916908 DOI: 10.1111/j.1365-2710.2010.01210.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Studies have shown that comprehensive interventions by pharmacists can improve adherence and persistence to osteoporosis therapy, but the association between adherence and bone turnover markers (BTMs) has never been studied. Therefore, the aim of this study was to evaluate the effects of pharmaceutical care on medication adherence (and its effects on BTMs), as well as persistence of postmenopausal osteoporotic women to prescribed bisphosphonates. METHODS A randomized controlled trial was conducted from 2005 to 2009 in the University Malaya Medical Centre, Malaysia. INCLUSION CRITERIA postmenopausal osteoporotic women diagnosed with osteoporosis with a T-score ≤ -2·5 or who had a low-trauma fracture and prescribed weekly alendronate/risedronate. Intervention participants received counselling on osteoporosis, risk factors, lifestyle modifications, goals of therapy, side effects and the importance of adherence. Adherence was assessed at months 3, 6 and 12, and persistence at month 12. Feedback on BTMs was provided at months 4 and 7. The control group received no counselling. Two BTMs were used: serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) and serum osteocalcin (OC). MAIN OUTCOMES MEASURED medication adherence, BTMs and persistence. RESULTS AND DISCUSSION Intervention participants who received pharmaceutical care reported significantly higher medication adherence at 6 (P = 0·015) and 12 months (P = 0·047) compared with the control group; but this effect was not shown by the BTMs. This is probably due to the long effect of bisphosphonates in bone. A significant difference was found between serum CTX-I and OC in identifying non-responders to anti-resorptive therapy (P < 0·001), indicating the usefulness of BTMs as an objective marker. However, pharmaceutical care did not affect persistence to osteoporosis therapy within a 1-year period [log rank (Mantel-Cox) χ² = 0·496, P = 0·481]. The proportion of participants who were persistent with bisphosphonate therapy after 12 months was 89·8% and 87·0% in the control and intervention group respectively. WHAT IS NEW AND CONCLUSION The provision of pharmaceutical care improved medication adherence but not persistence. BTMs were not appropriate objective measures for assessing adherence to weekly bisphosphonates but were useful for identifying non-responders to treatment within 3-6 months, much earlier than using bone mineral density. The study indicates that pharmacists have a role in improving medication adherence, but its long-term effect on persistence warrants further studies with longer duration.
Collapse
Affiliation(s)
- P S M Lai
- Medical Education Research and Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | | | | |
Collapse
|
16
|
Lai P, Chua SS, Chan SP. A systematic review of interventions by healthcare professionals on community-dwelling postmenopausal women with osteoporosis. Osteoporos Int 2010; 21:1637-56. [PMID: 20379700 DOI: 10.1007/s00198-010-1199-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women. Evidence available indicates that such interventions are effective in improving the quality of life, medication compliance, and calcium intake, but effect on other outcomes is less conclusive. INTRODUCTION The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women. METHODS Randomized controlled trials (RCTs) published in English between year 1990 and 2009 were identified. Types of patient outcome used as assessment included quality of life (QOL), bone mineral density (BMD), medication compliance and persistence, knowledge level, and lifestyle modification. RESULTS Twenty four RCTs met the inclusion criteria. Seven studies assessed interventions by physiotherapists, six by physicians, seven by nurses, three by multi-disciplinary teams and one by dietitians. Variability in the types and intensity of interventions made comparison between each study difficult. Collectively, these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD, medication persistence, knowledge, and other lifestyle modifications were less conclusive. CONCLUSIONS From this review, it was found that some outcome measures of such non-drug interventions still required further studies. Future studies should use validated instruments to assess the outcomes, with focus on common definitions of interventions and outcome measures, more intensive one-to-one interventions, appropriate control groups, adequate randomization procedures, and also provide information on effect size.
Collapse
Affiliation(s)
- P Lai
- Pharmacy Department, University of Malaya and University Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | | | | |
Collapse
|
17
|
Lai PSM, Chua SS, Chan SP, Low WY, Wong ICK. Development and validation of the osteoporosis patient satisfaction questionnaire (OPSQ). Maturitas 2009; 65:55-63. [PMID: 19962839 DOI: 10.1016/j.maturitas.2009.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 10/27/2009] [Accepted: 10/27/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop and validate the Osteoporosis Patient Satisfaction Questionnaire (OPSQ) and to assess the opinion of postmenopausal osteoporotic women towards pharmaceutical care. METHODS A 16-item instrument was designed. Each response consists of a five-point Likert-like scale with higher scores indicating greater satisfaction. The face and content validity was established via consultation with an endocrinologist and three pharmacists as well as feedback from participants in a preliminary study. Postmenopausal osteoporotic women taking bisphosphonates were recruited and randomly allocated to the intervention (n=90) and control groups (n=90). Pharmaceutical care was provided at month 2 to the intervention group while the control group received standard pharmacy services. The OPSQ was administered at month 6 (end of the intervention period), to assess patients' satisfaction. Factor analysis was performed using varimax rotation. Internal reliability was established using Cronbach's alpha. Construct validity was performed by using the Mann-Whitney U test. RESULTS The internal reliability of the OPSQ produced a Cronbach's alpha of 0.86. Factor analysis identified one component in the OPSQ, which measured patient satisfaction. The intervention group showed significantly better overall OPSQ score than the control group (91.89+/-7.22% versus 84.32+/-7.48%, p<0.001). This indicates that the OPSQ was able to differentiate between participants who received pharmaceutical care from those who did not. CONCLUSIONS The 16-item OPSQ developed in this study has high internal reliability and is a valid instrument for assessing osteoporotic women's satisfaction with pharmaceutical care service in Malaysia.
Collapse
Affiliation(s)
- Pauline S M Lai
- Pharmacy Unit, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
| | | | | | | | | |
Collapse
|
18
|
Gleeson T, Iversen MD, Avorn J, Brookhart AM, Katz JN, Losina E, May F, Patrick AR, Shrank WH, Solomon DH. Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 2009; 20:2127-34. [PMID: 19499273 PMCID: PMC3257053 DOI: 10.1007/s00198-009-0976-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/02/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY Adherence and persistence with osteoporosis medications are poor. We conducted a systematic literature review of interventions to improve adherence and persistence with osteoporosis medications. Seven studies met eligibility requirements and were included in the review. Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial. INTRODUCTION Adherence and persistence with pharmacologic therapy for osteoporosis are suboptimal. Our goal was to examine the design and efficacy of published interventions to improve adherence and persistence. METHODS We searched medical literature databases for English-language papers published between January 1990 and July 2008. We selected papers that described interventions and provided results for control and intervention subjects. We assessed the design and methods of each study, including randomization, blinding, and reporting of drop-outs. We summarized the results and calculated effect sizes for each trial. RESULTS Seven studies met eligibility requirements and were included in the review. Five of the seven studies provided adherence data. Of those five studies, three showed a statistically significant (p < or = 0.05) improvement in adherence by the intervention group, with effect sizes from 0.17 to 0.58. Five of the seven studies provided persistence data. Of those five, one reported statistically significant improvement in persistence by the intervention group, with an effect size of 0.36. CONCLUSIONS Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified in this small sample of studies. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial.
Collapse
Affiliation(s)
- T. Gleeson
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA
| | - M. D. Iversen
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. MGH Institute of Health Professions, Boston, MA, USA
| | - J. Avorn
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - A. M. Brookhart
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - J. N. Katz
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - E. Losina
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - F. May
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - A. R. Patrick
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - W. H. Shrank
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - D. H. Solomon
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
19
|
Abstract
BACKGROUND People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects. OBJECTIVES To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions. SEARCH STRATEGY We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles. SELECTION CRITERIA Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. DATA COLLECTION AND ANALYSIS Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis. MAIN RESULTS For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 81 interventions reported in 69 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. AUTHORS' CONCLUSIONS For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
Collapse
Affiliation(s)
- R B Haynes
- McMaster University, Clinical Epidemiology & Biostatistics and Medicine, Faculty of Health Sciences, 1200 Main Street West, Rm. 2C10B, Hamilton, Ontario, Canada L8N 3Z5.
| | | | | | | | | |
Collapse
|
20
|
Cram P, Schlechte J, Christensen A. A randomized trial to assess the impact of direct reporting of DXA scan results to patients on quality of osteoporosis care. J Clin Densitom 2006; 9:393-8. [PMID: 17097523 DOI: 10.1016/j.jocd.2006.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 08/30/2006] [Accepted: 09/11/2006] [Indexed: 11/29/2022]
Abstract
Consecutive patients identified as having osteoporosis on screening dual-energy X-ray absorptiometry (DXA) scans were randomized to: (1) a patient activation intervention consisting of mailing patients their DXA scan results supplemented by a call from a nurse educator or (2) usual care. Three months after the DXA scan, patients were contacted to assess: (1) use of antiresorptive therapy, (2) osteoporosis specific knowledge, and (3) satisfaction with their osteoporosis-related care. A total of 1,035 consecutive patients were screened to identify 422 eligible patients. Of these, 56 patients met inclusion criteria and were subsequently randomized. At follow-up, use of antiresorptive agents was numerically more common in the intervention arm (62%) than the control arm (54%), but this difference was not statistically significant (p=0.58). Patients in the intervention group were more likely to report being notified of their DXA results in a timely fashion (p=0.03), but osteoporosis-specific knowledge was similar.
Collapse
Affiliation(s)
- Peter Cram
- Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52240, USA.
| | | | | |
Collapse
|