提高澳大利亚养老院维生素 D 补充剂的使用率：维生素 D 实施（ViDAus）研究的结果。
Increasing the uptake of vitamin D supplement use in Australian residential aged care facilities: results from the vitamin D implementation (ViDAus) study.
机构信息
Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia.
John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
出版信息
BMC Geriatr. 2020 Oct 6;20(1):383. doi: 10.1186/s12877-020-01784-5.
BACKGROUND
Adequate (≥800 IU/day) vitamin D supplement use in Australian residential aged care facilities (RACFs) is variable and non-optimal. The vitamin D implementation (ViDAus) study aimed to employ a range of strategies to support the uptake of this best practice in participating facilities. The aim of this paper is to report on facility level prevalence outcomes and factors associated with vitamin D supplement use.
METHODS
This trial followed a stepped wedge cluster, non-randomised design with 41 individual facilities serving as clusters pragmatically allocated into two wedges that commenced the intervention six months apart. This multifaceted, interdisciplinary knowledge translation intervention was led by a project officer, who worked with nominated champions at participating facilities to provide education and undertake quality improvement (QI) planning. Local barriers and responsive strategies were identified to engage stakeholders and promote widespread uptake of vitamin D supplement use.
RESULTS
This study found no significant difference in the change of vitamin D supplement use between the intervention (17 facilities with approx. 1500 residents) and control group (24 facilities with approx. 1900 residents) at six months (difference in prevalence change between groups was 1.10, 95% CI - 3.8 to 6.0, p = 0.6). The average overall facility change in adequate (≥800 IU/day) vitamin D supplement use over 12 months was 3.86% (95% CI 0.6 to 7.2, p = 0.02), which achieved a facility level average prevalence of 59.6%. The variation in uptake at 12 months ranged from 25 to 88% of residents at each facility. In terms of the types of strategies employed for implementation, there were no statistical differences between facilities that achieved a clinically meaningful improvement (≥10%) or a desired prevalence of vitamin D supplement use (80% of residents) compared to those that did not.
CONCLUSIONS
This work confirms the complex nature of implementation of best practice in the RACF setting and indicates that more needs to be done to ensure best practice is translated into action. Whilst some strategies appeared to be associated with better outcomes, the statistical insignificance of these findings and the overall limited impact of the intervention suggests that the role of broader organisational and governmental support for implementation should be investigated further.
TRIAL REGISTRATION
Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ).
背景
澳大利亚养老院（RACF）中适当（≥800IU/天）维生素 D 补充剂的使用情况各不相同，且并不理想。维生素 D 实施（ViDAus）研究旨在采用一系列策略来支持参与设施采用这一最佳实践。本文旨在报告设施层面的流行率结果以及与维生素 D 补充剂使用相关的因素。
方法
本试验采用阶梯式楔形集群、非随机设计，41 个单独的设施作为集群，实用地分配到两个楔形中，每个楔形相隔六个月开始干预。这种多方面、跨学科的知识转化干预措施由一名项目官员领导，他与参与设施的指定负责人合作，提供教育并进行质量改进（QI）规划。确定了当地的障碍和应对策略，以吸引利益相关者并促进广泛采用维生素 D 补充剂。
结果
本研究发现，在六个月时，干预组（17 个设施，约 1500 名居民）和对照组（24 个设施，约 1900 名居民）之间维生素 D 补充剂使用的变化没有显著差异（两组间流行率变化的差异为 1.10，95%CI-3.8 至 6.0，p=0.6）。12 个月时，所有设施平均适当（≥800IU/天）维生素 D 补充剂使用率的总体变化为 3.86%（95%CI0.6 至 7.2，p=0.02），这达到了设施层面平均 59.6%的流行率。12 个月时，每个设施居民的吸收率从 25%到 88%不等。就实施所采用的策略类型而言，与未达到临床显著改善（≥10%）或维生素 D 补充剂使用期望流行率（80%的居民）的设施相比，达到这一目标的设施之间没有统计学差异。
结论
这项工作证实了在 RACF 环境中实施最佳实践的复杂性，并表明需要做更多的工作来确保最佳实践转化为行动。虽然某些策略似乎与更好的结果相关，但这些发现的统计学意义不显著，以及干预的总体影响有限表明，应该进一步调查更广泛的组织和政府对实施的支持作用。
试验注册
回顾性注册（ANZCTR ID：ACTRN12616000782437）。
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