Orthopaedic Management Improves the Rate of Early Osteoporosis Treatment After Hip Fracture

Miki, Roberto A.; Oetgen, Matthew E.; Kirk, Jessica; Insogna, Karl L.; Lindskog, Dieter M.

doi:10.2106/jbjs.g.01246

Cited by 81 publications

(60 citation statements)

References 31 publications

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“…Patient involvement was not reported by any of the studies. In four studies, the authors reported specific barriers to change that the intervention was tailored to address [37, 40, 42, 44]. Only one study reported that they had carried out substantial exploratory work to identify them [40] (literature reviews and qualitative in-depth interviews with healthcare professionals).…”

Section: Resultsmentioning

confidence: 99%

“…Only one study reported that they had carried out substantial exploratory work to identify them [40] (literature reviews and qualitative in-depth interviews with healthcare professionals). In two of the four studies, barriers were not identified and discussed until the end of the paper [37, 44]. Only one study designed the intervention to address all of the identified barriers [40]; the others offered no explanation as to why they had chosen particular barriers to target over others, with one study selecting a single barrier from a long list of barriers [44].…”

Section: Resultsmentioning

confidence: 99%

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Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework

2015

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BackgroundBehavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change.There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication.MethodsA behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted.ResultsNine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included “memory, attention and decision processes”, “knowledge”, “environmental context and resources”, “social influences” and “beliefs about consequences”. Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size.ConclusionsWhen explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0280-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework

2015

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“…Comparative studies conducted on orthopedic surgeon and physician-based interventions for improving osteoporosis management after hip fracture show awareness of orthopedic surgeon has a greater effect on osteoporosis management rates after hip fracture (20, 23). In particular, Miki et al (22) reported the effects of osteoporosis management initiated by an orthopedic team and by primary care physicians (22). The osteoporosis treatment rate 6 months after hip fracture was higher for the orthopedic team (58%) than for the primary care physicians (29%) (22).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, Miki et al (22) reported the effects of osteoporosis management initiated by an orthopedic team and by primary care physicians (22). The osteoporosis treatment rate 6 months after hip fracture was higher for the orthopedic team (58%) than for the primary care physicians (29%) (22). Our study also showed an improved medication rate of osteoporosis from 15% to 32%.…”

Section: Discussionmentioning

confidence: 99%

Orthopedic Surgeon's Awareness Can Improve Osteoporosis Treatment Following Hip Fracture: A Prospective Cohort Study

Kim

Park

et al. 2011

J Korean Med Sci

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Through retrospective Jeju-cohort study at 2005, we found low rates of detection of osteoporosis (20.1%) and medication for osteoporosis (15.5%) in those who experienced hip fracture. This study was to determine the orthopedic surgeons' awareness could increase the osteoporosis treatment rate after a hip fracture and the patient barriers to osteoporosis management. We prospectively followed 208 patients older than 50 yr who were enrolled for hip fractures during 2007 in Jeju-cohort. Thirty four fractures in men and 174 in women were treated at the eight hospitals. During the study period, orthopedic surgeons who worked at these hospitals attended two education sessions and were provided with posters and brochures. Patients were interviewed 6 months after discharge using an evaluation questionnaire regarding their perceptions of barriers to osteoporosis treatment. The patients were followed for a minimum of one year. Ninety-four patients (45.2%) underwent detection of osteoporosis by dual energy x-ray absorptiometry and 67 (32.2%) were prescribed medication for osteoporosis at the time of discharge. According to the questionnaire, the most common barrier to treatment for osteoporosis after a hip fracture was patients reluctance. The detection and medication rate for osteoporosis after hip fracture increased twofold after orthopedic surgeons had attended the intervention program. Nevertheless, the osteoporosis treatment rate remains inadequate.

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“…adherence to treatment [4][5][6][7][8][9][10][11][12][13][14][15]. Previous research suggests that the lack of awareness of current guidelines is one of the main obstacles to initiating therapy and that multifaceted interventions are required to improve treatment results as single interventions or basic information dissemination showed no significant increase in treatment rates [4,11,[16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

Banakh

2011

Arch Osteoporos

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Orthopaedic Management Improves the Rate of Early Osteoporosis Treatment After Hip Fracture

Abstract: An active role by orthopaedic surgeons in the management of osteoporosis improves the rate of treatment at six months following a hip fracture.

Cited by 81 publications

References 31 publications

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework

Orthopedic Surgeon's Awareness Can Improve Osteoporosis Treatment Following Hip Fracture: A Prospective Cohort Study

PRO-OSTEO Project (improving osteoporosis management in the acute hospital setting): a pilot single-centre study

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