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Randomized Controlled Trial
. 2015 May 12:16:214.
doi: 10.1186/s13063-015-0720-3.

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

Courtney C Kennedy  1 , George Ioannidis  2 , Lehana Thabane  3 , Jonathan D Adachi  4 , Sharon Marr  5 , Lora M Giangregorio  6 , Suzanne N Morin  7 , Richard G Crilly  8 , Robert G Josse  9 , Lynne Lohfeld  10 , Laura E Pickard  11 , Mary-Lou van der Horst  12 , Glenda Campbell  13 , Jackie Stroud  14 , Lisa Dolovich  15 , Anna M Sawka  16 , Ravi Jain  17 , Lynn Nash  18 , Alexandra Papaioannou  19   20
Affiliations
Randomized Controlled Trial

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

Courtney C Kennedy et al. Trials. .

Abstract

Background: Few 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.

Methods: We 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.

Results: At 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.

Conclusions: Our 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 registration: ClinicalTrials.gov: NCT01398527 . Registered: 19 July 2011.

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Figures

Figure 1
Figure 1
Flow-chart of randomization, allocation, follow-up and analysis.
Figure 2
Figure 2
ViDOS multifaceted intervention.
See this image and copyright information in PMC

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