TY - JOUR
T1 - Use of a decision aid to improve treatment decisions in osteoporosis
T2 - The osteoporosis choice randomized trial
AU - Montori, Victor M.
AU - Shah, Nilay D.
AU - Pencille, Laurie J.
AU - Branda, Megan E.
AU - Van Houten, Holly K.
AU - Swiglo, Brian A.
AU - Kesman, Rebecca L.
AU - Tulledge-Scheitel, Sidna M.
AU - Jaeger, Thomas M.
AU - Johnson, Ruth E.
AU - Bartel, Gregory A.
AU - Melton, L. Joseph
AU - Wermers, Robert A.
N1 - Funding Information:
Funding: The trial was funded by the Mayo Clinic Foundation for Medical Education and Research. The funding source had no role in the design, conduct, or decision to publish results of this trial.
Funding Information:
This trial was funded by the Mayo Clinic Foundation for Medical Education and Research. The funding source had no role in the design, conduct, or decision to publish results of this trial.
Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/6
Y1 - 2011/6
N2 - Objective: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed. Methods: Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles. Results: A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n = 52) or usual care (n = 48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n = 23 [100%] vs n = 14 [74%]; P = .009). Conclusion: A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.
AB - Objective: Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed. Methods: Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles. Results: A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n = 52) or usual care (n = 48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n = 23 [100%] vs n = 14 [74%]; P = .009). Conclusion: A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.
KW - Bisphosphonates
KW - Clinical trial
KW - Decision aid
KW - Osteoporosis
KW - Primary care
KW - Shared decision-making
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U2 - 10.1016/j.amjmed.2011.01.013
DO - 10.1016/j.amjmed.2011.01.013
M3 - Article
C2 - 21605732
AN - SCOPUS:79954625392
SN - 0002-9343
VL - 124
SP - 549
EP - 556
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 6
ER -