Wasim Baqir, William K. Gray, Alistair Blair, Shona Haining, Fraser Birrell
{"title":"骨质疏松症小组会诊和常规护理一样有效:一项非劣效性随机试验的结果","authors":"Wasim Baqir, William K. Gray, Alistair Blair, Shona Haining, Fraser Birrell","doi":"10.1002/lim2.3","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Group consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To show effectiveness in other musculoskeletal conditions with other professionals.</p>\n </section>\n \n <section>\n \n <h3> Hypothesis</h3>\n \n <p>Group consultations as effective as one-to-one consultations for treating patients at risk of osteoporotic fracture, defined by 10-year fracture risk.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Randomized controlled non-inferiority trial, with parallel groups randomized by patient</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>Three primary care practices, Northumberland, United Kingdom</p>\n </section>\n \n <section>\n \n <h3> Patients</h3>\n \n <p>A total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10-year fracture risk group.</p>\n </section>\n \n <section>\n \n <h3> Interventions</h3>\n \n <p>Pharmacist-led clinic appointment either in one of four 90-min group consultations (n = 75) or comparator usual care consultation (n = 83).</p>\n </section>\n \n <section>\n \n <h3> Measurements</h3>\n \n <p>Primary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Ten-year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23-0.92) for group and 0.54 (IQR = 0.15-0.92) for usual care (confirmed as non-inferior).</p>\n </section>\n \n <section>\n \n <h3> Limitations</h3>\n \n <p>Single pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Outcomes for group consultations were non-inferior to those for usual care in osteoporosis. Mean pharmacist contact time per patient was lower for group consultations, so this model was efficient and saved costs. Clinicians from different disciplines with facilitation skills can be trained easily and improve routine service delivery for chronic conditions through group consultations: a promising response to escalating demand for healthcare.</p>\n </section>\n </div>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2020-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/lim2.3","citationCount":"4","resultStr":"{\"title\":\"Osteoporosis group consultations are as effective as usual care: Results from a non-inferiority randomized trial\",\"authors\":\"Wasim Baqir, William K. Gray, Alistair Blair, Shona Haining, Fraser Birrell\",\"doi\":\"10.1002/lim2.3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Group consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To show effectiveness in other musculoskeletal conditions with other professionals.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Hypothesis</h3>\\n \\n <p>Group consultations as effective as one-to-one consultations for treating patients at risk of osteoporotic fracture, defined by 10-year fracture risk.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Randomized controlled non-inferiority trial, with parallel groups randomized by patient</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>Three primary care practices, Northumberland, United Kingdom</p>\\n </section>\\n \\n <section>\\n \\n <h3> Patients</h3>\\n \\n <p>A total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10-year fracture risk group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Interventions</h3>\\n \\n <p>Pharmacist-led clinic appointment either in one of four 90-min group consultations (n = 75) or comparator usual care consultation (n = 83).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Measurements</h3>\\n \\n <p>Primary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Ten-year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23-0.92) for group and 0.54 (IQR = 0.15-0.92) for usual care (confirmed as non-inferior).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Limitations</h3>\\n \\n <p>Single pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Outcomes for group consultations were non-inferior to those for usual care in osteoporosis. Mean pharmacist contact time per patient was lower for group consultations, so this model was efficient and saved costs. Clinicians from different disciplines with facilitation skills can be trained easily and improve routine service delivery for chronic conditions through group consultations: a promising response to escalating demand for healthcare.</p>\\n </section>\\n </div>\",\"PeriodicalId\":74076,\"journal\":{\"name\":\"Lifestyle medicine (Hoboken, N.J.)\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-08-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1002/lim2.3\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lifestyle medicine (Hoboken, N.J.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/lim2.3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lifestyle medicine (Hoboken, N.J.)","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/lim2.3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Osteoporosis group consultations are as effective as usual care: Results from a non-inferiority randomized trial
Background
Group consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.
Objective
To show effectiveness in other musculoskeletal conditions with other professionals.
Hypothesis
Group consultations as effective as one-to-one consultations for treating patients at risk of osteoporotic fracture, defined by 10-year fracture risk.
Design
Randomized controlled non-inferiority trial, with parallel groups randomized by patient
Setting
Three primary care practices, Northumberland, United Kingdom
Patients
A total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10-year fracture risk group.
Interventions
Pharmacist-led clinic appointment either in one of four 90-min group consultations (n = 75) or comparator usual care consultation (n = 83).
Measurements
Primary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.
Results
Ten-year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23-0.92) for group and 0.54 (IQR = 0.15-0.92) for usual care (confirmed as non-inferior).
Limitations
Single pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.
Conclusions
Outcomes for group consultations were non-inferior to those for usual care in osteoporosis. Mean pharmacist contact time per patient was lower for group consultations, so this model was efficient and saved costs. Clinicians from different disciplines with facilitation skills can be trained easily and improve routine service delivery for chronic conditions through group consultations: a promising response to escalating demand for healthcare.