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

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.

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

“…A meta-analysis by Cameron et al 35 reported that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. They also reported that vitamin D supplementation significantly reduced the rate of falls (Relative attributable risk [RaR], 0.63; 95% confidence interval, 0.46 to 0.86; five trials, 4603 participants), thus confirming a recent report by Kennedy et al 30 supporting the correction of vitamin D deficiency as an effective intervention to prevent falls in this setting.…”

“…30 It is expected that the use of a similar structured and multidisciplinary approach, which includes pharmacological as well as nonpharmacological interventions, could be very useful in the Australian context where access to prescriptions for osteoporosis is highly regulated and based on evidence of cost effectiveness.…”

How Can We Improve Osteoporosis Care? A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis

“…Approximately half of the studies evaluated quality improvement strategies for patient populations composed entirely of individuals with recent or prior fracture. Most studies reported outcomes of osteoporosis treatment and/or screening (BMD/DXA testing); only four reported fracture outcomes . Almost all included studies compared quality improvement strategies to control or usual care rather than an active comparator.…”

“…Meta‐analysis findings for strategies of multifaceted interventions targeting providers and patients, patient education and/or activation, and pharmacist initiation of screening in populations that included individuals without prior fracture did not show statistically significant improvement in outcomes of BMD/DXA testing or osteoporosis treatment. Furthermore, although we did not have enough similar studies that evaluated provider education and/or audit and feedback to perform meta‐analyses for these strategies, qualitative review of studies with interventions composed primarily of these strategies revealed that almost all of the studies did not find significant improvement in BMD testing and/or osteoporosis treatment outcomes …”

“…Most studies reported outcomes of osteoporosis treatment and/or screening (BMD/DXA testing); only four reported fracture outcomes. (28,29,40,61) Almost all included studies compared quality improvement strategies to control or usual care rather than an active comparator. Approximately two-thirds of studies reported a significant positive impact of an intervention on at least one outcome measure of interest.…”