Douglas W Roblin1, David Zelman2, Sally Plummer3, Brandi E Robinson4, Yiyue Lou5, Stephanie W Edmonds6, Fredric D Wolinsky7, Kenneth G Saag8, Peter Cram9. 1. Professor of Health Management and Policy at Georgia State University School of Public Health and a Consulting Senior Research Scientist at the Center for Clinical and Outcomes Research in Atlanta. droblin@gsu.edu. 2. At the time of this study was a Rheumatologist with The Southeast Permanente Medical Group, Inc, in Atlanta, GA. rheumexpert@gmail.com. 3. At the time of this study was a Consulting Nurse Educator at the Center for Clinical and Outcomes Research in Atlanta, GA. sallyplummer23@gmail.com. 4. Senior Project Manager at the Center for Clinical and Outcomes Research in Atlanta, GA. brandi.e.robinson@kp.org. 5. Biostatistician in the College of Public Health at the University of Iowa in Iowa City. yiyue-lou@uiowa.edu. 6. Graduate Research Assistant in Internal Medicine and a Doctoral Candidate in the College of Nursing at the University of Iowa in Iowa City. stephanie-edmonds@uiowa.edu. 7. The John W Colloton Chair in the College of Public Health at the University of Iowa in Iowa City. fredric-wolinsky@uiowa.edu. 8. Professor of Medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham. ksaag@uabmc.edu. 9. Professor of Internal Medicine in the Division of General Internal Medicine at the University of Toronto and the Director of General Internal Medicine at the University Health Network and Mount Sinai Hospital in Ontario, Canada. peter.cram@uhn.ca.
Abstract
CONTEXT: Evidence is inconclusive whether a nurse consultation can improve osteoporosis-related patient outcomes. OBJECTIVE: To evaluate whether a nurse consultation immediately after dual-energy x-ray absorptiometry (DXA) produced better osteoporosis-related outcomes than a simple intervention to activate adults in good bone health practices or usual care. DESIGN: Pilot randomized controlled trial, conducted within the larger Patient Activation After DXA Result Notification (PAADRN) trial (NCT01507662). After DXA, consenting adults age 50 years or older were randomly assigned to 3 groups: nurse consultation, PAADRN intervention (mailed letter with individualized fracture risk and an educational brochure), or usual care (control). Nurse consultation included reviewing DXA results, counseling on bone health, and ordering needed follow-up tests or physician referrals. MAIN OUTCOME MEASURES: Change from baseline to 52 weeks in participant-reported osteoporosis-related pharmacotherapy, lifestyle, activation and self-efficacy, and osteoporosis care satisfaction. RESULTS: Nurse consultation participants (n = 104) reported 52-week improvements in strengthening and weight-bearing exercise (p = 0.09), calcium intake (p < 0.01), osteoporosis knowledge (p = 0.04), activation (p < 0.01), dietary self-efficacy (p = 0.06), and osteoporosis care satisfaction (p < 0.01). Compared with PAADRN intervention participants (n = 39), nurse consultation participants had improved dietary self-efficacy (p = 0.07) and osteoporosis care satisfaction (p = 0.05). No significant improvements in osteoporosis-related outcomes were achieved vs PAADRN controls (n = 70). CONCLUSION: "Just-in-time" nurse consultation yielded a few improvements over 52 weeks in osteoporosis-related outcomes; however, most changes were not different from those obtained through the lower-cost PAADRN intervention or usual care.
RCT Entities:
CONTEXT: Evidence is inconclusive whether a nurse consultation can improve osteoporosis-related patient outcomes. OBJECTIVE: To evaluate whether a nurse consultation immediately after dual-energy x-ray absorptiometry (DXA) produced better osteoporosis-related outcomes than a simple intervention to activate adults in good bone health practices or usual care. DESIGN: Pilot randomized controlled trial, conducted within the larger Patient Activation After DXA Result Notification (PAADRN) trial (NCT01507662). After DXA, consenting adults age 50 years or older were randomly assigned to 3 groups: nurse consultation, PAADRN intervention (mailed letter with individualized fracture risk and an educational brochure), or usual care (control). Nurse consultation included reviewing DXA results, counseling on bone health, and ordering needed follow-up tests or physician referrals. MAIN OUTCOME MEASURES: Change from baseline to 52 weeks in participant-reported osteoporosis-related pharmacotherapy, lifestyle, activation and self-efficacy, and osteoporosis care satisfaction. RESULTS: Nurse consultation participants (n = 104) reported 52-week improvements in strengthening and weight-bearing exercise (p = 0.09), calcium intake (p < 0.01), osteoporosis knowledge (p = 0.04), activation (p < 0.01), dietary self-efficacy (p = 0.06), and osteoporosis care satisfaction (p < 0.01). Compared with PAADRN intervention participants (n = 39), nurse consultation participants had improved dietary self-efficacy (p = 0.07) and osteoporosis care satisfaction (p = 0.05). No significant improvements in osteoporosis-related outcomes were achieved vs PAADRN controls (n = 70). CONCLUSION: "Just-in-time" nurse consultation yielded a few improvements over 52 weeks in osteoporosis-related outcomes; however, most changes were not different from those obtained through the lower-cost PAADRN intervention or usual care.
Authors: Michael McClung; Steven T Harris; Paul D Miller; Douglas C Bauer; K Shawn Davison; Larry Dian; David A Hanley; David L Kendler; Chui Kin Yuen; E Michael Lewiecki Journal: Am J Med Date: 2012-11-20 Impact factor: 4.965
Authors: Stephanie W Edmonds; Fredric D Wolinsky; Alan J Christensen; Xin Lu; Michael P Jones; Douglas W Roblin; Kenneth G Saag; Peter Cram Journal: Contemp Clin Trials Date: 2012-10-17 Impact factor: 2.226
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