使用案例插图方法,这项研究表明,只有4%的患者口服双膦酸盐5年以上,和处方切换或停止治疗的20-30%的病例在每次访问。这些变化的决定因素很少。有关适当随访的更多信息可能有助于患者管理。
坚持口服双膦酸盐,最常用的抗骨质疏松治疗方法,是低的。这项研究的目的是评估风湿病学家对治疗模式的作用,并评估治疗变化的决定因素。
我们在142位风湿病学家的参与下使用了病例小插曲的方法。提出了三个基线临床小插曲:(1)要求医生指出安排下一次访问的最适当时期超过5年,(2)对医生进行了随访参数测试(包括陷阱),和(3)各种结果(包括临床,生物,光密度,和放射学)是随机给出的,并作为治疗变化的决定因素进行分析。
该研究允许评估426例虚拟临床病例。临床检查,病人的身高,关于瀑布的询问,在>90%的病例中,坚持治疗是必要的。在2、3和5年的22、40和71%的病例中测量了骨矿物质密度,分别。在少于25%的病例中,建议进行牙科随访。只有4.2%的患者在5年内维持相同的治疗,每次就诊时20-30%的病例发生治疗改变(停止或转换)。重要的决定因素是坚持治疗,血清C端1型胶原交联端肽(CTX)值,患者身高的变化,以及发生椎骨骨折。
我们的研究表明,由风湿病学家管理的绝经后妇女口服双膦酸盐的维持率很低;这些变化的决定因素很少,关于适当随访的更多信息可以帮助患者管理。
Using
case vignette methodology, this study shows that only 4% of patients are maintained on oral bisphosphonates over 5 years, and prescribers switch or stop the treatment in 20-30% of cases at each visit. There are few determinants of these changes. More information on appropriate follow-up could help in patients\' management.
Persistence to oral bisphosphonates, the most commonly prescribed anti-osteoporotic treatments, is low. The aim of this study was to evaluate the role of
rheumatologists on the treatment patterns, and to assess the determinants of treatment changes.
We used the methodology of
case vignettes with the participation of 142
rheumatologists. Three baseline clinical vignettes were presented: (1) the physician was asked to indicate the most appropriate period to schedule the next visit over 5 years, (2) the physician was tested about parameters for follow-up (including traps), and (3) various results (both clinical, biological, densitometric, and radiological) were given by random and analyzed as determinants of treatment changes.
The study allowed assessment of 426 virtual clinical cases. Clinical examinations, patient\'s height, inquiries about falls, and adherence to treatment were deemed necessary in > 90% of cases. Bone mineral density was measured in 22, 40, and 71% of cases at 2, 3, and 5 years, respectively. Dental follow-up was recommended in less than 25% of cases. Only 4.2% of patients were maintained on the same treatment at 5 years, and a change of treatment (stop or switch) occurs in 20-30% of cases at each visit. Significant determinants were adherence to treatment, serum C-terminal crosslinking telopeptide of type 1 collagen (CTX) value, change in patient\'s height, and the occurrence of an incident vertebral fracture.
Our study shows that maintenance of oral bisphosphonate in postmenopausal women managed by
rheumatologists is low; there are few determinants of these changes and more information on appropriate follow-up could help in patients\' management.