Abstract
Background: Osteoporosis is considered a major worldwide public health problem. Men and women with osteoporosis are mostly unaware of the illness, until bone fractures occur. It is estimated that more than one in three European women and one in five men over 50 years will experience osteoporotic fractures followed by considerable morbidity and mortality. In line with many other chronic illnesses, one of the pronounced challenges related to osteoporosis is
considered to be compliance and persistence to medical treatment. The causes of low compliance and persistence to treatment remain unclear. Living with a chronic illness often affects the entire human life situation, specifically, emotionally and existentially. How this is experienced personally and how this affects the individual’s life is still unknown.
Aim: To gain a deeper understanding of patients’ life with osteoporosis by determining the distribution and determinants of refill compliance and persistence to oral anti-osteoporotic treatment among new users of oral anti-osteoporotic therapy in Denmark as well as to explore the experiences of newly diagnosed women in terms of living with osteoporosis after pharmaceutical
osteoporosis treatment for fracture prevention had been prescribed.
Method: The quantitative study was a register-based national open cohort study of compliance and persistence of anti-osteoporotic therapy, comprising of 100,949 men and women. Statistical analysis including backward stepwise logistic regression analysis was used to explain causes of treatment failure and Kaplan Meier survival analysis to estimate persistence of treatment.
The qualitative study was a longitudinal study with a phenomenological-hermeneutic approach. Fifteen women with osteoporosis prescribed pharmaceutical preventive treatment were included. Data were obtained using individual interviews three times during one year. Data were analysed on
three levels: Naïve reading, structural analysis and critical interpretation and discussion.
Ethical considerations: The study was approved by the Danish Data Protection Agency (J.no. 2012-41-0875) and The National Committee on Health Research Ethics (J.no. H-C-FSP-2011_01).
Results: The register-based study (paper I) showed that 56.6% of the 93,365 patients were persistent and compliant, 4.7% were persistent with low refill-compliance, while 38.7% terminated treatment within the first year (“early quitters”). “Early quitters” were found to differ in socioeconomics demographics from other patients with low refill compliance. An increased risk of quitting during the first year of treatment compared with those who were refill-compliant for more than one year was found to be associated with: fractures overall (as one category), living in an apartment, children living at home, living alone, other bisphosphonates or non-bisphosphonates, male gender, living close to a university hospital, number of drugs, hormone replacement therapy,
prednisolone and anti-depressants, comorbidities 3+, pulmonary and collagen diseases.
In the interview study of “lived experiences” of osteoporosis the first six month three key themes emerged as well as sub themes: 1) “being diagnosed”: to be taken seriously, accepting the diagnosis. 2) “being prescribed medical treatment”: decision against the medical treatment, decision to pursue the medical treatment. 3) “being on the path of learning to live with osteoporosis”: acceptance – the need to adapt, lifestyle changes. Furthermore, in the one-year
longitudinal interview study found two key themes on to life with osteoporosis: 1) “to become influenced by the therapy”: taking the medication, stopping to take the medication. 2) “daily life with osteoporosis”: interpretation of symptoms, interpretation of scanning result and life style reflections.
Conclusion: These quantitative and qualitative findings together contribute to the current knowledge regarding compliance and persistent, determinants for potential risk groups as well as topical thematic areas central to newly-diagnosed women and main strategies for handling life with osteoporosis. These findings point to a new direction of health promotion areas which may be used
to suggest target actions when seeking to establish improved patient care and treatment. Patients need to be supported to interpret the diagnosis, fracture risk and decisions around medical treatment as related to life with osteoporosis to prevent osteoporotic fractures and promote bone health. Further research is needed to explore specific components of the multifaceted process of
learning to live with osteoporosis in an in-depth fashion.
considered to be compliance and persistence to medical treatment. The causes of low compliance and persistence to treatment remain unclear. Living with a chronic illness often affects the entire human life situation, specifically, emotionally and existentially. How this is experienced personally and how this affects the individual’s life is still unknown.
Aim: To gain a deeper understanding of patients’ life with osteoporosis by determining the distribution and determinants of refill compliance and persistence to oral anti-osteoporotic treatment among new users of oral anti-osteoporotic therapy in Denmark as well as to explore the experiences of newly diagnosed women in terms of living with osteoporosis after pharmaceutical
osteoporosis treatment for fracture prevention had been prescribed.
Method: The quantitative study was a register-based national open cohort study of compliance and persistence of anti-osteoporotic therapy, comprising of 100,949 men and women. Statistical analysis including backward stepwise logistic regression analysis was used to explain causes of treatment failure and Kaplan Meier survival analysis to estimate persistence of treatment.
The qualitative study was a longitudinal study with a phenomenological-hermeneutic approach. Fifteen women with osteoporosis prescribed pharmaceutical preventive treatment were included. Data were obtained using individual interviews three times during one year. Data were analysed on
three levels: Naïve reading, structural analysis and critical interpretation and discussion.
Ethical considerations: The study was approved by the Danish Data Protection Agency (J.no. 2012-41-0875) and The National Committee on Health Research Ethics (J.no. H-C-FSP-2011_01).
Results: The register-based study (paper I) showed that 56.6% of the 93,365 patients were persistent and compliant, 4.7% were persistent with low refill-compliance, while 38.7% terminated treatment within the first year (“early quitters”). “Early quitters” were found to differ in socioeconomics demographics from other patients with low refill compliance. An increased risk of quitting during the first year of treatment compared with those who were refill-compliant for more than one year was found to be associated with: fractures overall (as one category), living in an apartment, children living at home, living alone, other bisphosphonates or non-bisphosphonates, male gender, living close to a university hospital, number of drugs, hormone replacement therapy,
prednisolone and anti-depressants, comorbidities 3+, pulmonary and collagen diseases.
In the interview study of “lived experiences” of osteoporosis the first six month three key themes emerged as well as sub themes: 1) “being diagnosed”: to be taken seriously, accepting the diagnosis. 2) “being prescribed medical treatment”: decision against the medical treatment, decision to pursue the medical treatment. 3) “being on the path of learning to live with osteoporosis”: acceptance – the need to adapt, lifestyle changes. Furthermore, in the one-year
longitudinal interview study found two key themes on to life with osteoporosis: 1) “to become influenced by the therapy”: taking the medication, stopping to take the medication. 2) “daily life with osteoporosis”: interpretation of symptoms, interpretation of scanning result and life style reflections.
Conclusion: These quantitative and qualitative findings together contribute to the current knowledge regarding compliance and persistent, determinants for potential risk groups as well as topical thematic areas central to newly-diagnosed women and main strategies for handling life with osteoporosis. These findings point to a new direction of health promotion areas which may be used
to suggest target actions when seeking to establish improved patient care and treatment. Patients need to be supported to interpret the diagnosis, fracture risk and decisions around medical treatment as related to life with osteoporosis to prevent osteoporotic fractures and promote bone health. Further research is needed to explore specific components of the multifaceted process of
learning to live with osteoporosis in an in-depth fashion.
| Bidragets oversatte titel | Livet med osteoporose: en kohorte og kvalitativ undersøgelse |
|---|---|
| Originalsprog | Engelsk |
| Udgivelsessted | Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark |
|---|---|
| Vol/bind | serietal 2014/Rapport 1 |
| Antal sider | 164 |
| ISBN (Trykt) | 2244-9302 |
| Status | Udgivet - 28 jan. 2014 |