Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance,Osteoporosis International

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Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance
Osteoporosis International ( IF 4.2 ) Pub Date : 2022-06-11 , DOI: 10.1007/s00198-022-06453-4
Z Paskins _{1,

2} , O Babatunde ₁ , A Sturrock ₃ , L S Toh ₄ , R Horne ₅ , I Maidment ₆ ,

Affiliation

Summary

Systematic reviews that examine effectiveness of interventions to improve medicines optimisation do not explain how or why they work. This realist review identified that interventions which effectively optimise medicines use in osteoporosis include opportunities to address patients’ perceptions of illness and treatment and/or support primary care clinician decision making.

Introduction

In people with osteoporosis, adherence to medicines is poorer than other diseases and patients report follow-up is lacking, and multiple unmet information needs. We conducted a rapid realist review to understand what contextual conditions and mechanisms enable interventions to support osteoporosis medication optimisation.

Methods

A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation; a supplementary second search identified research of any design to gain additional insights on emerging findings. Extracted data was interrogated for patterns of context-mechanism-outcome configurations, further discussed in team meetings, informed by background literature and the Practicalities and Perception Approach as an underpinning conceptual framework.

Results

We identified 5 contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine). Interventions which support patient-informed decision making appear to influence long-term commitment to treatment. Supporting patients’ practical ability to adhere (e.g. by lowering treatment burden and issuing reminders) only appears to be helpful, when combined with other approaches to address patient beliefs and concerns. However, few studies explicitly addressed patients’ perceptions of illness and treatment. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence.

Conclusions

We identified a need for further research to identify a sustainable, integrated, patient-centred, and cost- and clinically effective model of long-term care for people with osteoporosis.

中文翻译：

支持患者从骨质疏松症治疗中获得最佳效果：快速现实地审查什么方法有效、对谁有效以及在什么情况下有效

概括

检查改善药物优化干预措施有效性的系统评价并不能解释它们如何或为何发挥作用。这项现实主义审查发现，有效优化骨质疏松症药物使用的干预措施包括解决患者对疾病和治疗的看法和/或支持初级保健临床医生决策的机会。

介绍

骨质疏松症患者的药物依从性比其他疾病差，患者报告缺乏随访，且多种信息需求未得到满足。我们进行了快速现实主义审查，以了解哪些背景条件和机制可以采取干预措施来支持骨质疏松症药物优化。

方法

初步搜索确定了旨在提高药物依从性或优化的观察性或介入性研究；补充性的第二次搜索确定了任何设计的研究，以获得对新发现的更多见解。对提取的数据进行了背景-机制-结果配置模式的询问，并在团队会议上进一步讨论，并以背景文献和实用性和感知方法作为基础概念框架。

结果

我们为骨质疏松症患者（发现问题；开始用药；继续用药）以及医生和医疗保健系统（做出诊断并给出治疗建议；审查药物）确定了 5 个背景时间点。支持患者知情决策的干预措施似乎会影响对治疗的长期承诺。仅当与解决患者信念和担忧的其他方法相结合时，支持患者的实际依从能力（例如通过减轻治疗负担和发出提醒）似乎才有帮助。然而，很少有研究明确探讨患者对疾病和治疗的看法。支持初级保健临床医生的决策以及初级和二级保健服务的整合对于提高治疗开始率和依从性似乎也很重要。