THE EDUCATIONAL PROGRAM FOR PATIENTS WITH OSTEOPOROSIS AND ITS IMPACT ON ADHERENCE TO TREATMENT: RESULTS OF A MULTICENTER RANDOMIZED TRIAL
Abstract
Introduction: Adherence to treatment in osteoporosis (OP) remains poor. Educating patients is the possible way for improving the situation. Purpose: To evaluate the effect of different forms of educational programs on treatment adherence. Materials and methods: 479 patients (mean age 66.1±7.9 years, 98.1% were women) with osteoporosis from seven centers of Russia were included in the study. The patients were randomly assigned to two groups. Treatment group (241 subjects) was trained at the School of the OP for 4 classes using interactive teaching methods with 7-10 people at a time. Patients of the control group (238 subjects) received information on the OP as a booklet. The number of patients taking calcium and vitamin D, as well as antiosteoporotic medications was not significantly different between groups at baseline. Patients had four centers interim visits at 3 and 6 months. The final visit for all patients was 12 months. Adherence was assessed at 12 months. Results: After the educational program 78.6% of study group and 80.1% of the control group took calcium with vitamin D regularly during 12 months (p>0.05). Antiosteoporotic medications were taken regularly by 55.4% of intervention and 35.1% of the control group, p<0,001. Other factors affecting adherence were: maternal hip fracture (OR=3,09; 1,55-6,16), intermediate visits at 3 and 6 months (OR=2,41; 1,47-3,96), the presence of disability group (OR=2,03; 1,35-3,06). Conclusion: Patient education in the classroom in small groups using interactive methods more effectively influences adherence than getting the information from a booklet.
About the Authors
L P EvstigneevaO M Lesnyak
kafedra semeynoy meditsiny FPK i PP
N M Kuznetsova
Yu A Safonova
kafedra sestrinskogo dela i sotsial'noy raboty
S V Bulgakova
otdelenie endokrinologii i osteoporoza Klinik
M N Kirpikova
kafedra terapii i ambulatornoy meditsiny FDPPO
M V Strunina
M V Telyuschenk
M R Nekrasova
O B Nesmeyanova
A A Vorob’yova
References
1. Остеопороз / под ред. О. М. Лесняк и Л. И. Беневоленской. — 2-е изд., перераб. и доп. — М. : ГЕОТАР-Медиа, 2009. — 272 с. (Серия «Клинические рекомендации»).
2. Kothawala P., Badamgarav E., Ryu S. et al. Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc. 2007 Dec; 82(12): 1493—501.
3. Huybrechts K.F., Ishak K.J., Caro J.J. Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone. 2006 Jun; 38(6): 922—8.
4. Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int. 2005; 16(2): 115—27.
5. Nielsen D., Ryg J., Nielsen W., Knold B., et al. Patient education in groups increases knowledge of osteoporosis and adherence to treatment: a two-year randomized controlled trial. Patient Educ Couns. 2010 Nov; 81(2): 155—60.
6. Little E.A., Eccles M.P. A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis. Implement Sci. 2010 Oct 22; 5: 80.
7. Школа здоровья. Остеопороз. Руководство для врачей / под ред. О. М. Лесняк. — М.: ГЕОТАР-Медиа, 2008. — 64 с.
8. Curtis J.R., McClure L.A., Delzell E. et al. Population-based fracture risk assessment and osteoporosis treatment disparities by race and gender. J Gen Intern Med. 2009 Aug; 24(8): 956—62.
9. Laliberté M.C., Perreault S., Dragomir A. et al. Impact of a primary care physician workshop on osteoporosis medical practices. Osteoporos Int. 2010 Sep; 21(9): 1471-85.
10. Shu A.D., Stedman M.R., Polinski J.M. et al. Adherence to osteoporosis medications after patient and physician brief education: post hoc analysis of a randomized controlled trial. Am J Manag Care. 2009 Jul; 15(7): 417-24.
11. Solomon D.H., Polinski J.M., Stedman M. et al. Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med. 2007 Mar; 22(3): 362—7.
12. Bessette L., Davison K.S., Jean S., et al. The impact of two educational interventions on osteoporosis diagnosis and treatment after fragility fracture: a population-based randomized controlled trial. Osteoporos Int. 2011 Feb 11.
13. Winzenberg T., Oldenburg B., Frendin S. et al. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial. BMC Public Health. 2006; 6: 12.
14. Majumdar S.R., Beaupre L.A., Harley C.H. et al. Use of a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial. Arch Intern Med. 2007 Oct 22; 167(19): 2110-5.
15. Davis J.C., Guy P., Ashe M.C., et al. HipWatch: osteoporosis investigation and treatment after a hip fracture: a 6-month randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2007 Aug; 62(8): 888—91.
16. Siris E.S., Harris S.T., Rosen C.J., et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc. 2006 Aug; 81(8): 1013—22.
17. Лесняк О. М., Евстигнеева Л. П., Коваль А. М. и др. Приверженность российских пациентов лечению остеопороза (национальный проект «Сила в постоянстве») Медицинский журнал «Фарматека». 2008; 3: 73—79.
18. Majumdar S.R., Johnson J.A., Bellerose D. et al. Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study. Osteoporos Int. 2011 Jan; 22(1): 223—30.
19. Majumdar S.R., Johnson J.A., McAlister F.A. et al. Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ. 2008 Feb 26; 178(5): 569—75.
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For citations:
Evstigneeva L.P., Lesnyak O.M., Kuznetsova N.M., Safonova Yu.A., Bulgakova S.V., Kirpikova M.N., Strunina M.V., Telyuschenk M.V., Nekrasova M.R., Nesmeyanova O.B., Vorob’yova A.A. THE EDUCATIONAL PROGRAM FOR PATIENTS WITH OSTEOPOROSIS AND ITS IMPACT ON ADHERENCE TO TREATMENT: RESULTS OF A MULTICENTER RANDOMIZED TRIAL. Osteoporosis and Bone Diseases. 2012;15(2):33-37. (In Russ.)
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