title: A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis.
abstract: BACKGROUND
  Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians.
  
  
  METHODS
  The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance.
  
  
  RESULTS
  The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial.
  
  
  CONCLUSIONS
  The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.
authors.forename: Monika
authors.initials: M
authors.lastname: Kastner
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.forename: Jemila
authors.initials: J
authors.lastname: Hamid
authors.forename: Maggie
authors.initials: M
authors.lastname: Chen
authors.forename: Kevin
authors.initials: K
authors.lastname: Thorpe
authors.forename: Mark
authors.initials: M
authors.lastname: Chignell
authors.forename: Joycelyne
authors.initials: J
authors.lastname: Ewusie
authors.forename: Christine
authors.initials: C
authors.lastname: Marquez
authors.forename: David
authors.initials: D
authors.lastname: Newton
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement; D057170:Translational Research, Biomedical / Q000379:methods*