nach oben

Journal of General Internal Medicine

Erschienen in:

01.12.2008 | Original Article

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

verfasst von: Monika Kastner, PhD, Sharon E. Straus, MD, FRCPC

Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2008

Einloggen, um Zugang zu erhalten

Abstract

BACKGROUND

Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps.

OBJECTIVE

To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management.

DATA SOURCES

Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field.

REVIEW METHODS

Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms.

RESULTS

Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17).

CONCLUSION

Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management.

Nur mit Berechtigung zugänglich

Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporosis Int. 1997;7:407–13.CrossRef

Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obst Gynecol. 2006;194:S3–11.CrossRef

National Osteoporosis Society. Available at: http://www.nos.org.uk/: Accessed September, 2008.

Osteoporosis Canada. Available at: http://www.osteoporosis.ca/english/home/: Accessed September, 2008.

Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of ostoporosis in patients with fragility fractures. CMAJ. 2000;163:819–22.PubMed

Johnell O, Kanis JA, Oden A, et al. Mortality after osteoporotic fractures. Osteoporosis Int. 2004;15:38–42.CrossRef

Reginster J, Burlet N. Osteoporosis: A still increasing prevalence. Bone. 2006;38:S4–9.PubMedCrossRef

Lips P, van Schoor NM. Quality of life in patients with osteoporosis. Osteoporosis Int. 2005;16:447–55.CrossRef

Goeree ROB, Pettitt DB, Cuddy L, et al. An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can. 1996;18(Suppl):15–24.

10.

Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. The Lancet. 2002;359:1761–7.CrossRef

11.

Poole KES, Compston JE. Clinical review: Osteoporosis and its management. BMJ. 2006;333:1251–6.PubMedCrossRef

12.

International Osteoporosis Foundation. Available at: http://www.iofbonehealth.org/facts-and-statistics.html: Accessed September 2008.

13.

Brown JP, Josse RG, for the Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada (revised, August 26, 2004). CMAJ. 2002;167(10):S1–34.PubMed

14.

Osteoporosis, Clinical Guidelines for Prevention and Treatment: Update on pharmacological interventions and algorithm for management. Royal College of Physicians, Bone and Tooth Society of Great Britain, 2003. Available at: http://www.rcplondon.ac.uk: Accessed September 2008.

15.

ACOG Committee on Practice Bulletins. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 50, January 2004. Osteoporosis Obstet Gynecol. 2004;103(1):203–16.

16.

Jaglal SB, McIsaac WJ, Hawker G, et al. Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporosis Int. 2003;14:672–6.CrossRef

17.

Jaglal SB, Carroll J, Hawker G, et al. How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Phys. 2003;49:462–8.

18.

Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD. The osteoporosis care gap in Canada. BMC Musculoskelet Disord. 2004;6:5–11.

19.

Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assessment. 2004;(86):iii–iv, 1–72.

20.

Smith SA, Murphy ME, Huschka TR, et al. Impact of a diabetes electronic management system on the care of patients seen in a subspecialty diabetes clinic. Diabetes Care. 1998;21:972–6.PubMedCrossRef

21.

Baker AM, Lafatat JE, Ward RE, Whitehouse F, Divine G. A web-based diabetes care management support system. J Qual Improv. 2001;27(4):179–90.

22.

Finkelstein J, O’connor G, Friedmann RH. Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care. Medinfo. 2001;10(Pt 1):810–4.

23.

Roccaforte R, Demers C, Baldassarre F, Teo KK, Yusuf S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur J Heart Fail. 2005;7(7):1133–44.PubMedCrossRef

24.

Gonseth J, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004;25:1570–95.PubMedCrossRef

25.

Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162(9):1289–94.PubMed

26.

Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR, Hedges Team. Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ. 2005;330(7501):1179.PubMedCrossRef

27.

Jüni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282(11):1054–60.PubMedCrossRef

28.

Moyer A, Finney JW. Rating methodologic quality: toward improved assessment and investigation. Account Res. 2005;12(4):299–313.PubMed

29.

Egger M, Smith GD, Altman DG. Systematic reviews in health care: Meta-analysis in context. London: BMJ Publishing Group; 2001:309–10;395–6.

30.

Barr RJ, Stewart A, Torgerson DJ, Seymour DG, Reid DM. Screening elderly women for risk of future fractures—Participation rates and impact on incidence of falls and fractures. Calcif Tissue Int. 2005;76:243–8.PubMedCrossRef

31.

Bliuc D, Eisman JA, Center JR. A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int. 2006;17(9):1309–17.PubMedCrossRef

32.

Boyd JL, Holcomb JP, Rothenberg RJ. Physician treatment of osteoporosis in response to heel ultrasound bone mineral density reports. J Clin Densitometry. 2002;5(4):375–81.CrossRef

33.

Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: a randomized controlled trial. Aust J of Physiother. 2005;51:102–8.

34.

Feldstein A, Elmer PJ, Smith DH, et al. Electronic medical record reminder improves osteoporosis management after a fracture: a randomized, controlled trail. J Am Geriatr Soc. 2006;54(3):450–7.PubMedCrossRef

35.

Gardner MJ, Brophy RH, Demetrakopoulos D, et al. Interventions to improve osteoporosis treatment following hip fracture. J Bone and Joint Surg. 2005;87:3–7.CrossRef

36.

LaCroix AZ, Buist DSM, Brenneman SK, Abbott TA. Evaluation of three population-based strategies for fracture prevention. Medical Care. 2005;43:293–302.PubMedCrossRef

37.

McDonough RP, Doucette WR, Kumbera P, Klepser DG. An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis. Value in Health. 2005;8(1):24–31.PubMedCrossRef

38.

Morrison LS, Tobias JH. Effect of a case-finding strategy for osteoporosis on bisphosphonate prescribing in primary care. Osteoporosis Int. 2005;16(1):71–7.CrossRef

39.

Rolnick SJ, Kopher R. What is the impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting? Menopause. 2001;8(2):141–8.PubMedCrossRef

40.

Solomon DH, Katz JN, La Tourette AM, Coblyn JS. Multifaceted intervention to improve reumatologists’ management of glucocorticoid-induced osteoporosis: A randomized controlled trial. Arthritis & Rheumatism. 2004;51:383–7.CrossRef

41.

Solomon DH, Finkelsteing JS, Polinski JM, et al. A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporosis Int. 2006;17:760–7.CrossRef

42.

Solomon DH, Polinski JM, Stedman M, et al. Improving care of patients at-risk for osteoporosis: A randomized controlled trial. J Gen Intern Med. 2007;22(3):362–7.PubMedCrossRef

43.

Allen ML, Wyatt LE. Guidelines for the diagnosis, screening, and treatment of osteoporosis in women. Adv Studies Med. 2005;5(10):518–23.

44.

Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev. 2005;25(1):CD004017, Jan.

45.

Bai B, Wang KZ, Liu WK, Song JH, Chen JC. Comprehensive treatment for old patients with hip fractures. Chin J Traumatol. 2003;6(5):297–301.PubMed

46.

Berard A, Bravo G, Gauthier P. Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporosis Int. 1997;7(4):331–7.CrossRef

47.

Berarducci A. The effects of an osteoporosis preventive cognitive/behavioural intervention on knowledge, self-efficacy, role strain, and intention in midlife women. University of South Florida PhD dissertation.

48.

Blalock SJ, Currey SS, DeVellis RF, et al. Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behaviour. Am J Health Prom. 2000;14(3):161–9.

49.

Bonaiuti D, Cranney A, Iovine R, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2002;(3):CD000333.

50.

Boulos P, Adachi JD. Guidelines for the prevention and therapy of glucocorticoid-induced osteoporosis. Clin Exp Rheumatol. 2000;18(Suppl 21):S79–86.

51.

Brenneman SK, Lacroix AZ, Buist DSM, Chen Y, Abbott TA III. Evaluation of decision rules to identify postmenopausal women for inervention related to osteoporosis. Dis Manage. 2003;6:159–68.CrossRef

52.

Buist DSM, LaCroix AZ, Manfredonia D, Abbott T. Identifying postmenopausal women at high risk of fracture in populations: a comparison of three strategies. J Am Geriatrics Soc. 2002;50(6):1031–8.CrossRef

53.

Colon-Emeric CS, Caminis J, Suh TT, et al. The HORIZON Recruitment Fracture Trial: Design of a clinical trial in the prevention of subsequent fractures after low trauma hip fracture repair. Curr Med Res Opin. 2004;20(6):903–10.PubMedCrossRef

54.

Delafuente JC, Weakley DF. Can an educational program for residents of assisted living facilities improve drug utilization for osteoporosis? Consultant Pharmacist. 2005;20(2):137–40.PubMed

55.

Devogelaer J-P, Goemaere S, Boonen S, et al. Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: A consensus document of the Belgian Bone Club. Osteoporosis Int. 2006;17(1):8–19.CrossRef

56.

Dhillon V, Creiger J, Hannan J, Hurst N, Nuki G. The effect of DXA scanning on clinical decision making by general practitioners: A randomized, prospective trial of direct access versus referral to a hospital consultant. Osteoporosis Int. 2003;14:326–33.CrossRef

57.

Edwards BJ, Brooks ER, Langman CB. Osteoporosis screening of postmenopausal women in the primary care setting: A case-based approach. Gender Med. 2004;1(2):70–85.CrossRef

58.

Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results osf a randomized, clinical trial. J Am Geriatr Soc. 2004;52:1471–8.PubMedCrossRef

59.

Hunskaar S, Hannestad YS, Backe B, Matheson I. Direct, mailing of consensus recommendations did not alter GPs’ knowledge and prescription of oestrogen in the menopause. Scand J Prim Health Care. 1996;14(4):203–8.PubMedCrossRef

60.

Josse R, Tenengouse AM, Hanley DA, et al. Clinical practice guidelines for the diagnosis and management of osteoporosis. CMAJ. 1996;155(8):1113–29.

61.

Lock CA, Lecouturier J, Mason JM, Dickinson HO. Lifestyle interventions to prevent osteoporotic fractures: A systematic review. Osteoporosis Int. 2006;17(1):20–8.CrossRef

62.

McGinley AM. Effect of Web-based computer-tailoring on women’s intention to continue or begin to use hormone replacement therapy to lower their risk for osteoporosis. University of Pennsylvania PhD Dissertation 2002.

63.

Nelson ME, Fiatarone MA, Morganit CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial. JAMA. 1994;272:1909–14.PubMedCrossRef

64.

O’Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003;(2):CD001431.

65.

Polinski JM, Brookhart MA, Katz JN, et al. Educational outreach (academic detailing) regarding osteoporosis in primary care. Pharmacoepidemiol Drug Safety. 2005;14:843–50.CrossRef

66.

Feder G, Cryer D, Donovan S, Carter Y. Guidelines for the prevention of falls in people over 65. BMJ. 2000;321:1007–11.PubMedCrossRef

67.

Rothert ML, Holmes-Rovner M, Rovner D, et al. An educational intervention as decision support for menopausal women. Res Nurs Health. 1997;20(5):377–87.PubMedCrossRef

68.

Silverman SL, Greenwald M, Klein RA, Drinkwater BL. Effect of bone density information on decisions about hormone replacement therapy: a randomized trail. Obstetrics Gynecol. 1997;89(3):321–5.CrossRef

69.

Stock JL, Waud CE, Coderre JA, et al. Clinical reporting to primary care physicians leads to increased use and understanding of bone densitometry and affects the management of osteoporosis. A randomized trial. Ann Intern Med. 1998;128(12 Pt 1):996–9.PubMed

70.

Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G. The effect on behaviour and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial. BMC Pub Health. 2006;6:12.CrossRef

71.

Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam consultation on meta-analysis. J Clin Epidemiol. 1995;48:167–71.PubMedCrossRef

72.

Sullivan F, Wyatt JC. How decision support tools help define clinical problems. BMJ. 2005;331:831–3.PubMedCrossRef

73.

Randolph AG, Haynes RB, Wyatt JC, Cook DJ, Guyatt GH. Users’ guides to the medical literature XVII. How to use an article evaluating the clinical impact of a computer-based clinical decision support system. JAMA. 1999;281:67–74.CrossRef

74.

Garg AX, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38.PubMedCrossRef

75.

Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330:765–73.PubMedCrossRef

Titel: Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials
verfasst von: Monika Kastner, PhD
Sharon E. Straus, MD, FRCPC
Publikationsdatum: 01.12.2008
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 12/2008
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0812-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Wo hapert es noch bei der Umsetzung der POMGAT-Leitlinie?

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Das Risiko für Vorhofflimmern in der Bevölkerung steigt

02.05.2024 Vorhofflimmern Nachrichten

Das Risiko, im Lauf des Lebens an Vorhofflimmern zu erkranken, ist in den vergangenen 20 Jahren gestiegen: Laut dänischen Zahlen wird es drei von zehn Personen treffen. Das hat Folgen weit über die Schlaganfallgefährdung hinaus.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Abstract

BACKGROUND

OBJECTIVE

DATA SOURCES

REVIEW METHODS

RESULTS

CONCLUSION

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2008

Two Deaths

Author Reply

Pneumococcal Vaccination in General Internal Medicine Practice: Current Practice and Future Possibilities

Patient Sex Does Not Modify Ejection Fraction as a Predictor of Death in Heart Failure: Insights from the APPROACH Cohort

Engaging Homeless Persons in End of Life Preparations