Successful knowledge translation intervention in long-term care: final results from the vitamin D and osteoporosis study ViDOS pilot cluster randomized controlled trialReportar como inadecuado




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Trials

, 16:214

First Online: 12 May 2015Received: 17 July 2014Accepted: 13 April 2015DOI: 10.1186-s13063-015-0720-3

Cite this article as: Kennedy, C.C., Ioannidis, G., Thabane, L. et al. Trials 2015 16: 214. doi:10.1186-s13063-015-0720-3

Abstract

BackgroundFew studies have systematically examined whether knowledge translation KT strategies can be successfully implemented within the long-term care LTC setting. In this study, we examined the effectiveness of a multifaceted, interdisciplinary KT intervention for improving the prescribing of vitamin D, calcium and osteoporosis medications over 12-months.

MethodsWe conducted a pilot, cluster randomized controlled trial in 40 LTC homes 21 control; 19 intervention in Ontario, Canada. LTC homes were eligible if they had more than one prescribing physician and received services from a large pharmacy provider. Participants were interdisciplinary care teams physicians, nurses, consultant pharmacists, and other staff who met quarterly. Intervention homes participated in three educational meetings over 12 months, including a standardized presentation led by expert opinion leaders, action planning for quality improvement, and audit and feedback review. Control homes did not receive any additional intervention. Resident-level prescribing and clinical outcomes were collected from the pharmacy database; data collectors and analysts were blinded. In addition to feasibility measures, study outcomes were the proportion of residents taking vitamin D ≥800 IU-daily; primary, calcium ≥500 mg-day and osteoporosis medications high-risk residents over 12 months. Data were analyzed using the generalized estimating equations technique accounting for clustering within the LTC homes.

ResultsAt baseline, 5,478 residents, mean age 84.4 standard deviation SD 10.9, 71% female, resided in 40 LTC homes, mean size = 137 beds SD 76.7. In the intention-to-treat analysis 21 control; 19 intervention clusters, the intervention resulted in a significantly greater increase in prescribing from baseline to 12 months between intervention versus control arms for vitamin D odds ratio OR 1.82, 95% confidence interval CI: 1.12, 2.96 and calcium OR 1.33, 95% CI: 1.01, 1.74, but not for osteoporosis medications OR 1.17, 95% CI: 0.91, 1.51. In secondary analyses, excluding seven nonparticipating intervention homes, ORs were 3.06 95% CI: 2.18, 4.29, 1.57 95% CI: 1.12, 2.21, 1.20 95% CI: 0.90, 1.60 for vitamin D, calcium and osteoporosis medications, respectively.

ConclusionsOur KT intervention significantly improved the prescribing of vitamin D and calcium and is a model that could potentially be applied to other areas requiring quality improvement.

Trial RegistrationClinicalTrials.gov: NCT01398527. Registered: 19 July 2011.

KeywordsFracture long-term care Vitamin D prescribing knowledge translation AbbreviationsViDOSvitamin D and osteoporosis study

LTClong-term care

KTknowledge translation

RCTrandomized controlled trial

ORodds ratio

SDstandard deviation

eMARelectronic Medication Administration Record

CIconfidence interval

GEEgeneralized estimating equations

ITTintention-to-treat

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Fuente: https://link.springer.com/







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