1
|
Wang M, Seibel MJ. Secondary fracture prevention in primary care: a narrative review. Osteoporos Int 2024:10.1007/s00198-024-07036-1. [PMID: 38652313 DOI: 10.1007/s00198-024-07036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/28/2024] [Indexed: 04/25/2024]
Abstract
The global burden of osteoporosis continues to rise with an ageing population. Untreated osteoporotic fractures not only heighten the risk of subsequent fractures but are associated with excess mortality. Although primary care guidelines consistently stress the importance of secondary fracture prevention, fewer than 20% of patients are appropriately treated for osteoporosis following an initial osteoporotic fracture. This worldwide phenomenon is known as the osteoporosis care gap. This literature review examines the barriers to secondary fracture prevention in primary care and evaluates the effectiveness of targeted primary care interventions. Common themes emerged from the majority of qualitative studies, including a need for improved communication between the hospital team and primary care, better defined responsibilities and osteoporosis-directed education for the primary care physicians. Quantitative studies demonstrated that most targeted, intensive interventions aimed at educating patients and their primary care physician about osteoporosis treatment significantly increased rates of investigation and treatment. Greater uptake of models of secondary fracture prevention in primary care is urgently needed to address the osteoporosis care gap.
Collapse
Affiliation(s)
- Mawson Wang
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia.
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia.
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord Campus, Hospital Rd, Gate 3, Concord, NSW, Australia
- Department of Endocrinology and Metabolism, Concord Hospital, Sydney Local Health District, Concord, NSW, Australia
| |
Collapse
|
2
|
Pradhan AB, Nicholls E, Edwards JJ, Welsh V, Paskins Z. Bone health assessment in adults with fragility fracture risk factors between 2002-2014: a retrospective cohort study. BJGP Open 2024; 8:BJGPO.2023.0084. [PMID: 37648258 PMCID: PMC11169976 DOI: 10.3399/bjgpo.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Lifetime risk of fragility fractures is 50% in post-menopausal women and 20% in men aged >50 years. Identifying people at high risk facilitates early intervention and reduction of biopsychosocial morbidity associated with these fractures. AIM To explore if bone health assessment (BHA) rates differ between women and men aged ≥50 years with fragility fracture risk factors. DESIGN & SETTING A primary care-based cohort study in North Staffordshire, UK. METHOD Patients were identified from the Consultations in Primary Care Archive (CiPCA) database between 2002 and 2014 with one or more fragility fracture risk factors (previous fractures, falls, and prolonged steroid use). Evaluation of BHA within 12 months of presentation of the first risk factor was carried out by searching for codes for fracture risk assessment tools (FRAX and QFracture), bone density measurement, specialist service referral, or if bone-protection medication was started. RESULTS A total of 15 581 patients with risk factors were identified; men represented 40.4% of the cohort. The study found 1172 (7.5%) had BHA performed within 1 year of presentation, and 8.9% of women and 5.5% of men had BHAs, which was found with strong statistical evidence (χ2 = 59.88, P = 1 × 10-14). This relationship prevailed after adjusting for other covariates, such as comorbidity and number of consultations, with an odds ratio of 1.25 (95% confidence interval [CI] = 1.08 to 1.43). CONCLUSION This study has shown that rates of BHA were generally low and even lower in men compared with women. Primary care clinicians should be alert to fragility fracture risk factors in both men and women to enable early assessment and intervention.
Collapse
Affiliation(s)
- Anup Bahadur Pradhan
- School of Medicine, David Weatherall Building, Keele University, Keele, UK
- Belvidere Medical Practice, Shrewsbury, UK
| | - Elaine Nicholls
- School of Medicine, David Weatherall Building, Keele University, Keele, UK
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - John James Edwards
- School of Medicine, David Weatherall Building, Keele University, Keele, UK
- Wolstanton Medical Centre, Wolstanton, UK
| | - Victoria Welsh
- School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Zoe Paskins
- School of Medicine, David Weatherall Building, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, UK
| |
Collapse
|
3
|
Sahota O, Narayanasamy M, Bastounis A, Paskins Z, Bishop S, Langley T, Gittoes N, Davis S, Baily A, Holmes M, Leonardi-Bee J. Bisphosphonate alternative regimens for the prevention of osteoporotic fragility fractures: BLAST-OFF, a mixed-methods study. Health Technol Assess 2024; 28:1-169. [PMID: 38634483 PMCID: PMC11056815 DOI: 10.3310/wypf0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background Bisphosphonates are a class of medication commonly used to treat osteoporosis. Alendronate is recommended as the first-line treatment; however, long-term adherence (both treatment compliance and persistence) is poor. Alternative bisphosphonates are available, which can be given intravenously and have been shown to improve long-term adherence. However, the most clinically effective and cost-effective alternative bisphosphonate regimen remains unclear. What is the most cost-effective bisphosphonate in clinical trials may not be the most cost-effective or acceptable to patients in everyday clinical practice. Objectives 1. Explore patient, clinician and stakeholder views, experiences and preferences of alendronate compared to alternative bisphosphonates. 2. Update and refine the 2016 systematic review and cost-effectiveness analysis of bisphosphonates, and estimate the value of further research into their benefits. 3. Undertake stakeholder/consensus engagement to identify important research questions and further rank research priorities. Methods The study was conducted in two stages, stages 1A and 1B in parallel, followed by stage 2: • Stage 1A - we elicited patient and healthcare experiences to understand their preferences of bisphosphonates for the treatment of osteoporosis. This was undertaken by performing a systematic review and framework synthesis of qualitative studies, followed by semistructured qualitative interviews with participants. • Stage 1B - we updated and expanded the existing Health Technology Assessment systematic review and clinical and cost-effectiveness model, incorporating a more comprehensive review of treatment efficacy, safety, side effects, compliance and long-term persistence. • Stage 2 - we identified and ranked further research questions that need to be answered about the effectiveness and acceptability of bisphosphonates. Results Patients and healthcare professionals identified a number of challenges in adhering to bisphosphonate medication, balancing the potential for long-term risk reduction against the work involved in adhering to oral alendronate. Intravenous zoledronate treatment was generally more acceptable, with such regimens perceived to be more straightforward to engage in, although a portion of patients taking alendronate were satisfied with their current treatment. Intravenous zoledronate was found to be the most effective, with higher adherence rates compared to the other bisphosphonates, for reducing the risk of fragility fracture. However, oral bisphosphonates are more cost-effective than intravenous zoledronate due to the high cost of zoledronate administration in hospital. The importance of including patients and healthcare professionals when setting research priorities is recognised. Important areas for research were related to patient factors influencing treatment selection and effectiveness, how to optimise long-term care and the cost-effectiveness of delivering zoledronate in an alternative, non-hospital setting. Conclusions Intravenous zoledronate treatment was generally more acceptable to patients and found to be the most effective bisphosphonate and with greater adherence; however, the cost-effectiveness relative to oral alendronate is limited by its higher zoledronate hospital administration costs. Future work Further research is needed to support people to make decisions influencing treatment selection, effectiveness and optimal long-term care, together with the clinical and cost-effectiveness of intravenous zoledronate administered in a non-hospital (community) setting. Limitations Lack of clarity and limitations in the many studies included in the systematic review may have under-interpreted some of the findings relating to effects of bisphosphonates. Trial registration This trial is registered as ISRCTN10491361. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127550) and is published in full in Health Technology Assessment; Vol. 28, No. 21. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Opinder Sahota
- Department of Health Care for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Zoe Paskins
- School of Medicine, Keele University and Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Simon Bishop
- Business School, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Sarah Davis
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ann Baily
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Moira Holmes
- Lay Member, Nottingham Osteoporosis Society Patient Support group, Nottingham, UK
| | - Jo Leonardi-Bee
- School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
4
|
Rezae F, Kelly A, Dey S, Moles R, Carter S. Healthcare professionals' perspectives and experiences of osteoporosis medication treatment: a qualitative systematic review. Arch Osteoporos 2024; 19:8. [PMID: 38191760 DOI: 10.1007/s11657-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024]
Abstract
This systematic review aimed to explore healthcare professionals' (HCPs) experiences and perspectives of osteoporosis medication treatment through thematic synthesis of qualitative studies. We found themes about how osteoporosis is perceived as a disease, treatment decision-making and what empowers HCPs to provide the best possible care. PURPOSE The systematic review aimed to describe the perspectives and experiences of HCPs regarding osteoporosis medication treatment. METHODS We performed searches in four electronic databases (Medline, Embase, PsycINFO and CINAHL) from database inception until May 2023 in any language. Data was analysed through inductive thematic synthesis. RESULTS We included 27 primary studies that incorporated the views of 495 different HCPs. The following themes were identified: low-priority disease, challenges in treatment decision-making, minimising drug burden, conscious of communication barriers, fragmented care and advice, confidence through experience and collaboration. CONCLUSIONS HCPs were enthusiastic about optimising osteoporosis care through interprofessional collaboration and expertise, as well as educating and monitoring patients on treatment. They advocated for safety, comfort and reducing overall drug burden, especially in older patients with comorbidities. However, they had differences in opinions regarding who has responsibility for diagnosing and treating osteoporosis and struggled to provide the best possible care due to competing priorities, limited time and lack of adequate knowledge or evidence. The findings highlight the important and complementary role of different HCPs in osteoporosis treatment through a multidisciplinary model of care.
Collapse
Affiliation(s)
- Fatima Rezae
- School of Pharmacy, University of Sydney, Sydney, Australia.
| | - Ayano Kelly
- Rheumatology Department, Liverpool Hospital, Sydney, Australia
- Ingham Institute of Applied Medical Research, Sydney, Australia
- School of Health and Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Sagarika Dey
- School of Clinical Medicine, South Western Sydney Campus, University of New South Wales, Sydney, Australia
| | - Rebekah Moles
- School of Pharmacy, University of Sydney, Sydney, Australia
| | - Stephen Carter
- School of Pharmacy, University of Sydney, Sydney, Australia
| |
Collapse
|
5
|
Mougui A, El Bouchti I. Management of Postmenopausal Osteoporosis by Moroccan General Practitioners: A Cross-Sectional Survey. Curr Rheumatol Rev 2024; 20:100-106. [PMID: 37526187 DOI: 10.2174/1573397119666230731122645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Despite the existence of effective treatments and prescribed therapeutic protocols, there is a lack of management of osteoporosis, resulting in increased secondary morbidity and mortality. The general practitioner (GP) is the first-line practitioner for the detection and management of osteoporosis. OBJECTIVE This study was conducted to explore the practices, knowledge, and difficulties in postmenopausal osteoporosis management reported by GPs. METHODS An anonymous questionnaire (19 questions) was created via Google Forms and distributed to 300 GPs via social networks (WhatsApp, Facebook, and Gmail). The survey results were automatically calculated on "Google Forms" and checked using SPSS.20 software. RESULTS A total of 129 responses were received, representing a response rate of 43%. The majority of respondents were women (67.2%). The definition of osteoporosis was variable, with 51.6% defining it as a T-score of ≤-2.5 SD, 25.8% defining it as diffuse bone demineralization, and 12.1% defining it as a fracture after falling with low energy. Prolonged corticosteroid therapy was the most commonly indicated reason for measuring bone mineral density (BMD) (81.39%). The calcium phosphate balance was the most requested (90.1%). Vitamin D and calcium supplementation were reported by 74.41% and 54.26% of GPs, respectively. Fracture of the upper end of the femur was the main therapeutic indication (65.11%). Most GPs surveyed (73.3%) were unfamiliar with the fracture risk assessment tool (FRAX). Most of the GPs gave advice on fall prevention to their patients (83.72%), and 62.5% of GPs monitored their patients' height. Anti-osteoporosis treatment was maintained for 3 to 5 years by 44.96% of GPs. CONCLUSION Our survey found that the practices and knowledge of GPs on osteoporosis vary widely and often deviate from the recommended standards. This highlights the need for more excellent education of GPs, due to their vital role in the management of osteoporosis.
Collapse
Affiliation(s)
- Ahmed Mougui
- Department of Rheumatology, Arrazi Hospital, Faculty of Medicine and Pharmacy of Marrakech, Mohammed VI University Hospital, Marrakech, Morocco
| | - Imane El Bouchti
- Department of Rheumatology, Arrazi Hospital, Faculty of Medicine and Pharmacy of Marrakech, Mohammed VI University Hospital, Marrakech, Morocco
| |
Collapse
|
6
|
Manning F, Mahmoud A, Meertens R. Understanding patient views and acceptability of predictive software in osteoporosis identification. Radiography (Lond) 2023; 29:1046-1053. [PMID: 37734275 DOI: 10.1016/j.radi.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Research into patient and public views on predictive software and its use in healthcare is relatively new. This study aimed to understand older adults' acceptability of an opportunistic bone density assessment for osteoporosis diagnosis (IBEX BH), views on its integration into healthcare, and views on predictive software and AI in healthcare. METHODS Focus groups were conducted with participants aged over 50 years, based in South West England. Data were analysed using thematic analysis. Analysis was informed by the theoretical framework of acceptability. RESULTS Two focus groups were undertaken with a total of 14 participants. Overall, the participants were generally positive about the IBEX BH software, and predictive software's in general stating 'it sounds like a brilliant idea'. Although participants did not understand the intricacies of the software, they did not feel they needed to. Concerns about IBEX BH focussed more on the clinical indications of the software (e.g. more scans or medications), with participants expressing less trust in results if they indicated medication. Questions were also raised about how and who would receive the results of this software. Individual choice was evident in these discussions, however most indicated the preferences for spoken communication 'But I would expect that these results would be given by a human to another human.' CONCLUSIONS Focus group participants were generally accepting of the use of predictive software in healthcare. IMPLICATIONS FOR PRACTICE Thought and care needs to be taken when integrating predictive software into practice. Focusses on empowering patients, providing information on processes and results are key.
Collapse
Affiliation(s)
- F Manning
- Department of Health and Care Professions, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - A Mahmoud
- Department of Health and Community Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK.
| | - R Meertens
- Department of Health and Care Professions, University of Exeter Medical School, University of Exeter, Exeter, UK.
| |
Collapse
|
7
|
Bishop S, Narayanasamy MJ, Paskins Z, Corp N, Bastounis A, Griffin J, Gittoes N, Leonardi-Bee J, Langley T, Sahota O. Clinicians' views of prescribing oral and intravenous bisphosphonates for osteoporosis: a qualitative study. BMC Musculoskelet Disord 2023; 24:770. [PMID: 37770860 PMCID: PMC10540377 DOI: 10.1186/s12891-023-06865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Bisphosphonate medications, including alendronate, ibandronate and risedronate administered orally and zoledronate, administered intravenously, are commonly prescribed for the treatment of osteoporosis based on evidence that, correctly taken, bisphosphonates can improve bone strength and lead to a reduction in the risk of fragility fractures. However, it is currently unclear how decisions to select between bisphosphonate regimens, including intravenous regimen, are made in practice and how clinicians support patients with different treatments. METHODS This was an interpretivist qualitative study. 23 semi-structured telephone interviews were conducted with a sample of general practitioners (GPs), secondary care clinicians, specialist experts as well as those providing and leading novel treatments including participants from a community intravenous (IV) zoledronate service. Data analysis was undertaken through a process of iterative categorisation. RESULTS The results report clinicians varying experiences of making treatment choices, as well as wider aspects of osteoporosis care. Secondary care and specialist clinicians conveyed some confidence in making treatment choices including on selecting IV treatment. This was aided by access to diagnostic testing and medication expertise. In contrast GPs reported a number of challenges in prescribing bisphosphonate medications for osteoporosis and uncertainty about treatment choice. Results also highlight how administering IV zoledronate was seen as an opportunity to engage in broader care practices. CONCLUSION Approaches to making treatment decisions and supporting patients when prescribing bisphosphonates for osteoporosis vary in practice. This study points to the need to co-ordinate osteoporosis treatment and care across different care providers.
Collapse
Affiliation(s)
- Simon Bishop
- Nottingham University Business School, University of Nottingham, Nottingham, NG5 1PB, UK.
| | | | - Zoe Paskins
- School of Medicine, Keele University, David Weatherall Building, Newcastle-Under-Lyme, UK
- ST5 5BG and Haywood Academic Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-On-Trent, ST6 7AG, UK
| | - Nadia Corp
- School of Primary, Community and Social Care, Keele University, Newcastle-Under-Lyme, ST5 5BG, UK
| | - Anastasios Bastounis
- Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, NG5 1PB, UK
| | - Jill Griffin
- Royal Osteoporosis Society (ROS), St James House, The Square, Lower Bristol Road, Bath, BA2 3BH, UK
| | - Neil Gittoes
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Tessa Langley
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Opinder Sahota
- Department of Healthcare of Older People, Nottingham University Hospitals NHS Trust, Nottingham, NG72UH, UK
| |
Collapse
|
8
|
Hawarden A, Bullock L, Chew-Graham CA, Herron D, Hider S, Jinks C, Erandie Ediriweera De Silva R, Machin A, Paskins Z. Incorporating FRAX into a nurse-delivered integrated care review: a multi-method qualitative study. BJGP Open 2023; 7:BJGPO.2022.0146. [PMID: 36746471 PMCID: PMC10354387 DOI: 10.3399/bjgpo.2022.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at increased risk of common comorbidities including osteoporosis. AIM To explore the barriers to and facilitators of implementing nurse-delivered fracture risk assessments in primary care, in the context of multimorbidity reviews for people with IRCs. DESIGN & SETTING A multi-method qualitative study in primary care. METHOD As part of a process evaluation in a pilot trial, semi-structured interviews were conducted with 20 patients, two nurses, and three GPs. Twenty-four patient-nurse INCLUDE review consultations were audiorecorded and transcribed. A framework analysis was conducted using the Theoretical Domains Framework (TDF). RESULTS Nurses reported positive views about the value of the Fracture Risk Assessment Tool (FRAX) and they felt confident to deliver the assessments following training. Barriers to implementation, as identified by TDF, particularly related to the domains of knowledge, skills, professional roles, and environmental context. GPs reported difficulty keeping up to date with osteoporosis guidelines and voiced differing opinions about whether fracture risk assessment was the role of primary or secondary care. Lack of integration of FRAX into IT systems was a barrier to use. GPs and nurses had differing views about the nurse role in communicating risk and acting on FRAX findings; for example, explanations of the FRAX result and action needed were limited. Patients reported limited understanding of FRAX outcomes. CONCLUSION The findings suggest that, with appropriate training including risk communication, practice nurses are likely to be confident to play a key role in conducting fracture risk assessments, but further work is needed to address the barriers identified.
Collapse
Affiliation(s)
| | | | | | - Daniel Herron
- Department of Psychology, School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Risni Erandie Ediriweera De Silva
- School of Medicine, Keele University, Keele, UK
- Department of Family Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Staffordshire, UK
| |
Collapse
|
9
|
Laird C, Williams KA, Benson H. Perceptions and practices of aged care pharmacists regarding osteoporosis management: a qualitative study. Int J Clin Pharm 2023:10.1007/s11096-023-01586-w. [PMID: 37162657 PMCID: PMC10366014 DOI: 10.1007/s11096-023-01586-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/25/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Osteoporosis is a common but sub-optimally managed disease among aged care residents. Although pharmacists are one of the key healthcare providers responsible for osteoporosis medication management there is limited research on their involvement. AIM This study explored the perceptions and practices of Australian pharmacists regarding osteoporosis management for aged care residents. METHOD Semi-structured interviews were conducted with aged care pharmacists. Interviews were recorded, transcribed, and analysed using a constructivist grounded theory approach. RESULTS Twenty-one aged care pharmacists were interviewed. Three main themes were identified: osteoporosis is highly prevalent but given low priority, factors affecting pharmacists' management of osteoporosis, and optimism for the future role of pharmacists in osteoporosis management. The complexity of aged care residents' healthcare needs and the silent, insidious nature of osteoporosis contribute to the low priority it is afforded. Barriers identified by pharmacists included their current practice model, limited access to residents' medical histories and difficulties accessing bone mineral density (BMD) testing. Interdisciplinary collaboration and education regarding osteoporosis management were seen as facilitators. Pharmacists were optimistic that an embedded practice model would improve their capacity to influence osteoporosis management. CONCLUSION The high prevalence and low priority of osteoporosis in the aged care setting presents pharmacists with an opportunity to improve medication management and reduce fracture risk. Barriers to osteoporosis management identified by pharmacists can be addressed by interdisciplinary collaboration and education. Pharmacists being embedded in aged care could enable more opportunities to contribute to the interdisciplinary team and become champions of osteoporosis management.
Collapse
Affiliation(s)
- Catherine Laird
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| | - Helen Benson
- Graduate School of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| |
Collapse
|
10
|
Geusens P, Appelman-Dijkstra NM, Zillikens MC, Willems H, Lems WF, van den Bergh J. How to implement guidelines and models of care. Best Pract Res Clin Rheumatol 2022; 36:101759. [PMID: 35729036 DOI: 10.1016/j.berh.2022.101759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.
Collapse
Affiliation(s)
- Piet Geusens
- Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands.
| | - Natasha M Appelman-Dijkstra
- Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Hanna Willems
- Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands.
| | - Joop van den Bergh
- Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands.
| |
Collapse
|
11
|
Zhou X, Li X, Wei T, Xu Y, Mao Y, Lei C. A Prospective Evaluation of the Awareness, Knowledge, and Management of Osteoporosis in a Cohort of Medical Staff. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4201180. [PMID: 35669375 PMCID: PMC9167110 DOI: 10.1155/2022/4201180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the differences in the awareness, knowledge, and management of osteoporosis from a cohort of medical staff after educational intervention. Methods A total of 653 medical workers from different departments related to the prevention and treatment of osteoporosis from 7 hospitals in Ningxia were enrolled. Information was collected using a designed questionnaire. Results After 5 years of educational intervention and follow-up, medical staff had an increased understanding of osteoporosis diagnosis, including dual-energy X-ray, ultrasound bone sonometer, fragility fracture history, biochemistry markers, and the awareness of the susceptible population. However, there was no improvement in the cognition of single/dual photo absorptiometry, symptoms and signs, and bone turnover index. Their understanding of antiosteoporosis drugs, especially the application of calcitonin, diphosphates, and vitamin D, was significantly promoted, while the perception of indicators and time in follow-up, some adverse drug reactions, and exercise therapy remained unchanged. Medical staff were remarkably less aware of the management of follow-up for osteoporosis, exercise and diet therapy, and bone turnover markers. Conclusion A great gap was identified in the perception of osteoporosis among medical staff in the Ningxia region. After the educational intervention, the knowledge regarding some aspects of osteoporosis generally improved. Much more effort should be made to strengthen the training and learning on the special detection methods of osteoporosis, medications and exercise therapy, and follow-up management.
Collapse
Affiliation(s)
- Xiaoling Zhou
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Xin Li
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Tingting Wei
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Ying Xu
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Yuanyuan Mao
- Department of Geriatrics and Special Needs, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| | - Chen Lei
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
| |
Collapse
|
12
|
Bell A, Kendler DL, Khan AA, Shapiro C M M, Morisset A, Leung JP, Reiner M, Colgan SM, Slatkovska L, Packalen M. A retrospective observational study of osteoporosis management after a fragility fracture in primary care. Arch Osteoporos 2022; 17:75. [PMID: 35513573 PMCID: PMC9072526 DOI: 10.1007/s11657-022-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
In many countries, osteoporosis is predominantly managed by primary care physicians; however, management after a fragility fracture has not been widely investigated. We describe osteoporosis care gaps in a real-world patient cohort. Our findings help inform initiatives to identify and overcome obstacles to effective management of patients after fragility fracture. PURPOSE A fragility fracture is a major risk factor for subsequent fracture in adults aged ≥ 50 years. This retrospective observational study aimed to characterize post-fracture management in Canadian primary care. METHODS A total of 778 patients with an index fragility fracture (low-trauma, excluding small bones) occurring between 2014 and 2016 were identified from medical records at 76 primary care centers in Canada, with follow-up until January 2018. RESULTS Of 778 patients (80.5% female, median age [IQR] 73 [64-80]), 215 were on osteoporosis treatment and 269 had osteoporosis diagnosis recorded prior to their index fracture. The median follow-up was 363 (IQR 91-808) days. Of patients not on osteoporosis treatment at their index fracture, 60.2% (n = 339/563) remained untreated after their index fracture and 62.2% (n = 23/37) continued untreated after their subsequent fracture. After their index fracture, fracture risk assessment (FRAX or CAROC) was not performed in 83.2% (n = 647/778) of patients, and 59.9% (n = 466/778) of patients did not receive bone mineral density testing. Of patients without osteoporosis diagnosis recorded prior to their index date, 61.3% (n = 300/489) remained undiagnosed after their index fracture. At least one subsequent fracture occurred in 11.5% (n = 86/778) of patients. CONCLUSION In the primary care setting, fragility fracture infrequently resulted in osteoporosis treatment or fracture risk assessment, even after multiple fragility fractures. These results suggest a fragility fracture is not recognized as a major risk factor for subsequent fracture and its occurrence does not prompt primary care physicians to intervene. These data urge initiatives to identify and overcome obstacles to primary care physicians' effective management of patients after fragility fractures.
Collapse
Affiliation(s)
- Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - David L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Aliya A Khan
- Department of Medicine, Divisions of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Marla Shapiro C M
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne Morisset
- Department of Medicine, Division of Internal Medicine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Jean-Pierre Leung
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | | |
Collapse
|
13
|
Tay CL, Ng WL, Beh HC, Lim WC, Hussin N. Screening and management of osteoporosis: a survey of knowledge, attitude and practice among primary care physicians in Malaysia. Arch Osteoporos 2022; 17:72. [PMID: 35474021 PMCID: PMC9041673 DOI: 10.1007/s11657-022-01111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
We surveyed primary care physicians in Malaysia for their knowledge, attitude and practice in screening and managing osteoporosis. We found a low level of screening and active management of osteoporosis in the primary care setting despite positive attitudes towards them. We advocate for the active management of osteoporosis at the primary care level. INTRODUCTION Prevention of osteoporotic fracture is important in primary healthcare for healthy ageing. Little is known about the knowledge, attitude, practice and barriers in the screening and managing osteoporosis among primary care doctors. METHODS A cross-sectional study, using an online pre-tested questionnaire after face and content validation, was conducted for primary care doctors from 1 June to 30 July 2021 across Malaysia. Pearson's chi-square test and logistic regression were employed. RESULTS A total of 350 primary care doctors in Malaysia, consisting of 113 (32.3%) family medicine specialists (FMS) and 237 (67.7%) medical officers, participated in this study. The mean ± SD score of osteoporosis knowledge was 50.46 ± 15.09 with minimum and maximum values of 0 and 83.64%, respectively. One hundred and ten (31.4%) respondents achieved a satisfactory overall knowledge score of ≥ 60%, 156 (44.6%) were confident in advising patients for initiation of anti-osteoporotic medication, and 243 (69.4%) perceived that bisphosphonate should be made available in health clinics. Only 97 (27.7%) practised osteoporosis screening. Inaccessibility of bone mineral densitometry (BMD) (90.6%), inadequate knowledge (87.7%) and inaccessibility of pharmacotherapy (87.1%) are perceived modifiable barriers to osteoporosis screening and management. Factors associated with a satisfactory knowledge of osteoporosis are designation as a family medicine specialist (AOR 3.034, p = 0.002), attendance at an osteoporosis management update course (AOR 2.095, p = 0.034) and the practice of osteoporosis screening for the elderly (AOR 2.767, p = 0.001). CONCLUSION Given the insufficient knowledge and low level of osteoporosis screening, there is a need for a national structured health programme to address the knowledge gap, increase screening practices and enhance accessibility to BMD and anti-osteoporosis medication in primary care.
Collapse
Affiliation(s)
- Chai Li Tay
- Simpang Health Clinic, Health District Office of Larut, Matang and Selama, Ministry of Health Malaysia, Perak, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Hooi Chin Beh
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Chieh Lim
- Geriatric Medicine Unit, Department of Internal Medicine, Taiping Hospital, Ministry of Health Malaysia, Perak, Malaysia
| | - Narwani Hussin
- Clinical Research Centre, Taiping Hospital, Ministry of Health Malaysia, Perak, Malaysia
| |
Collapse
|
14
|
O'Gorman CA, Minnock S, Mulhall J, Gleeson N. Attention to bone health in follow-up of gynaecological cancers in tertiary care. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065211070747. [PMID: 34994250 PMCID: PMC8744201 DOI: 10.1177/17455065211070747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Women with gynaecological cancers are at an increased risk of cancer treatment-induced bone loss, which impacts on their quality of life and overall survival. Clinical cancer follow-up reviews focus on cancer status and fail to attend to important health and quality-of-life issues. We questioned whether there was a care-gap between tertiary clinicians and primary care physicians in the management of bone health in this cohort. Significant care-gaps in relation to bone health have been demonstrated in other oncologic settings. The objective of this study was to determine the level of attention to bone health in the care of women living with and beyond gynaecological cancer at a tertiary referral centre for gynaecological oncology. METHODS Retrospective, observational cohort study of attention to bone health in the management and follow-up of gynaecological cancers. RESULTS This study shows that there has been suboptimal attention from the carers at a cancer centre to bone health during the oncological follow up of women undergoing treatment for gynaecological cancer. In those at particular risk of cancer treatment-induced bone loss (iatrogenic menopause and/or external beam pelvic radiotherapy), 52% of women had no reference to bone health in their notes, and 57% had no assessment of bone mineral density. CONCLUSION Tertiary cancer carers may underestimate the importance of bone health or believe that it falls outside the remit of their gynaecologic oncology service. Further research is needed to explore whether these findings are indicative of a true care gap and to gain insight into possible corrective measures.
Collapse
Affiliation(s)
- Catherine A O'Gorman
- Department of Gynecological Oncology, St. James' Hospital, Dublin, Ireland.,Department of Gynecology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sorcha Minnock
- Department of Gynecology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Joseph Mulhall
- Department of Gynecology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Noreen Gleeson
- Department of Gynecological Oncology, St. James' Hospital, Dublin, Ireland.,Department of Gynecology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
15
|
Ravn Jakobsen P, Hermann AP, Søendergaard J, Kock Wiil U, Myhre Jensen C, Clemensen J. The gap between women's needs when diagnosed with asymptomatic osteoporosis and what is provided by the healthcare system: A qualitative study. Chronic Illn 2021; 17:3-16. [PMID: 30525980 DOI: 10.1177/1742395318815958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Women diagnosed with asymptomatic osteoporosis need better support to understand the implications of the condition and how to practice self-management in their daily lives. In contrast, physicians report that asymptomatic osteoporosis is not a serious chronic condition and do not pay much attention to the condition compared to other chronic conditions. Therefore, the aim of this study was to investigate the gap between women's needs, when diagnosed with asymptomatic osteoporosis, and what is provided by the healthcare system. METHODS A secondary analysis of semi-structured interviews with 17 women newly diagnosed with asymptomatic osteoporosis was conducted and combined with semi-structured interviews with six physicians. Giorgi's descriptive phenomenological method was used in the analysis. RESULTS Two overall themes were identified: different perceptions of asymptomatic osteoporosis and discrepancies in the osteoporosis consultation. Habermas was used as a theoretical approach to discuss the findings. DISCUSSION We discuss that physicians pay too much attention to the objective world and highlight that there is a need for better inclusion of women's subjective and social worlds, to enable mutual understanding and communicative action in the osteoporosis consultation. This would lead to treatment decisions based on women's needs and support women in their self-management of osteoporosis.
Collapse
Affiliation(s)
- Pernille Ravn Jakobsen
- University College South Denmark, Haderslev, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | | | - Jens Søendergaard
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Uffe Kock Wiil
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Charlotte Myhre Jensen
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,HC Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
16
|
Miller KL, Steffen MJ, McCoy KD, Cannon G, Seaman AT, Anderson ZL, Patel S, Green J, Wardyn S, Solimeo SL. Delivering fracture prevention services to rural US veterans through telemedicine: a process evaluation. Arch Osteoporos 2021; 16:27. [PMID: 33566174 PMCID: PMC7875846 DOI: 10.1007/s11657-021-00882-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
An informatics-driven population bone health clinic was implemented to identify, screen, and treat rural US Veterans at risk for osteoporosis. We report the results of our implementation process evaluation which demonstrated BHT to be a feasible telehealth model for delivering preventative osteoporosis services in this setting. PURPOSE An established and growing quality gap in osteoporosis evaluation and treatment of at-risk patients has yet to be met with corresponding clinical care models addressing osteoporosis primary prevention. The rural bone health tea m (BHT) was implemented to identify, screen, and treat rural Veterans lacking evidence of bone health care and we conducted a process evaluation to understand BHT implementation feasibility. METHODS For this evaluation, we defined the primary outcome as the number of Veterans evaluated with DXA and a secondary outcome as the number of Veterans who initiated prescription therapy to reduce fracture risk. Outcomes were measured over a 15-month period and analyzed descriptively. Qualitative data to understand successful implementation were collected concurrently by conducting interviews with clinical personnel interacting with BHT and BHT staff and observations of BHT implementation processes at three site visits using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. RESULTS Of 4500 at-risk, rural Veterans offered osteoporosis screening, 1081 (24%) completed screening, and of these, 37% had normal bone density, 48% osteopenia, and 15% osteoporosis. Among Veterans with pharmacotherapy indications, 90% initiated therapy. Qualitative analyses identified barriers of rural geography, rural population characteristics, and the infrastructural resource requirement. Data infrastructure, evidence base for care delivery, stakeholder buy-in, formal and informal facilitator engagement, and focus on teamwork were identified as facilitators of implementation success. CONCLUSION The BHT is a feasible population telehealth model for delivering preventative osteoporosis care to rural Veterans.
Collapse
Affiliation(s)
- Karla L. Miller
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Melissa J. Steffen
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
| | - Kimberly D. McCoy
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
| | - Grant Cannon
- Department of Internal Medicine, Rheumatology Section, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Aaron T. Seaman
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Division of Genera l Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, IA USA
| | - Zachary L. Anderson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Anesthesiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Shardool Patel
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Department of Anesthesiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Janiel Green
- VA Office of Rural Health, Veterans Rural Health Resource Center-Salt Lake City (VRHRC-SLC), Salt Lake City, UT USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT USA
| | - Shylo Wardyn
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
| | - Samantha L. Solimeo
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Salt Lake City, UT USA
- Comprehensive Access & Delivery Research and Evaluation (CADRE), Primary Care Analytics Team Iowa City (PCAT-IC), Department of Veterans Affairs, CADRE, Iowa City VA HCS, Research 152, 601 Highway 6 West, Iowa City, IA 52246 USA
- Division of Genera l Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242 Iowa City, IA USA
| |
Collapse
|
17
|
Papaioannou A, McCloskey E, Bell A, Ngui D, Mehan U, Tan M, Goldin L, Langer A. Use of an electronic medical record dashboard to identify gaps in osteoporosis care. Arch Osteoporos 2021; 16:76. [PMID: 33893868 PMCID: PMC8068625 DOI: 10.1007/s11657-021-00919-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified. PURPOSE To identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk. METHODS The ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool. RESULTS Eighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG. CONCLUSION Despite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.
Collapse
Affiliation(s)
- A. Papaioannou
- McMaster University, Hamilton, Ontario Canada ,GERAS Centre for Aging Research, St. Peter’s Hospital, Hamilton Health Sciences, 88 Maplewood Ave, Hamilton, Ontario L8M 1W9 Canada
| | - E. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - A. Bell
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - D. Ngui
- University of British Columbia, Vancouver, British Columbia Canada
| | - U. Mehan
- McMaster University, Hamilton, Ontario Canada ,Centre for Family Medicine Family Health Team, Kitchener, Ontario Canada
| | - M. Tan
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - L. Goldin
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| | - A. Langer
- Canadian Centre for Professional Development in Health and Medicine, Toronto, Ontario Canada
| |
Collapse
|
18
|
Paskins Z, Crawford-Manning F, Cottrell E, Corp N, Wright J, Jinks C, Bishop S, Doyle A, Ong T, Gittoes N, Leonardi-Bee J, Langley T, Horne R, Sahota O. Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis. BMJ Open 2020; 10:e040634. [PMID: 33148763 PMCID: PMC7640526 DOI: 10.1136/bmjopen-2020-040634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING Any developed country healthcare setting. PARTICIPANTS Patients, healthcare professionals, managers, payers and academics. INTERVENTION Experiences and views of oral and intravenous bisphosphonates. RESULTS Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER CRD42019143526.
Collapse
Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
| | - Alison Doyle
- Operations and Clinical Practice, Royal Osteoporosis Society, Bath, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
19
|
Stuart AL, Pasco JA, Mohebbi M, Kotowicz MA, Holloway-Kew KL, Hosking SM, Williams LJ. Osteoporosis medication use among Australian women over two decades. Arch Osteoporos 2020; 15:67. [PMID: 32372368 DOI: 10.1007/s11657-019-0661-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/17/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite the burden of osteoporosis and treatment availability, a treatment gap remains. Women in a population-based study were followed with respect to use of anti-fracture medication over two decades. Use increased over time but remained suboptimal, with less than 20% of those at high risk of fracture receiving treatment. PURPOSE We examined trends in osteoporosis-related medication use over time using data from the Geelong Osteoporosis Study, an ongoing, population-based study. METHODS Self-reported medication use data were available for 822 women (50-90 years) at time-1 (1993-1997), 575 women at time-2 (2004-2008), and 527 women at time-3 (2011-2014) participating in a longitudinal study. Prevalence of any osteoporosis-related medication use (pooled anti-fracture (bisphosphonates, raloxifene, denosumab, or strontium); hormone therapy; and supplements (calcium and/or vitamin D)) was calculated using bootstrapping methods for the whole group and those at risk of fracture, identified using FRAX Aus® (probability of major osteoporotic fracture ≥ 20% and/or ≥ 3% hip fracture) and BMD (osteoporosis indicated by a T-score of less than - 2.5 at either the femoral neck or spine). Time trend (age groups 50-59, 60-69, 70-79, 80+ years) and time-point effects were evaluated using mixed effects logistic models. RESULTS The use of any osteoporosis-related medication increased over three time points (time-1, 25.9% (95% CI 23.1, 28.8); time-2, 32.5% (28.7, 36.3); time-3, 35.9% (31.9, 39.8)), driven by the use of supplements (time-1, 12.9% (95% CI 10.6, 15.1); time-2, 22.1% (18.8, 25.4); time-3, 30.9% (26.9, 35.5)) and anti-fracture medication (time-1, 0.9% (0.4, 1.6); time-2, 5.0% (3.3, 6.8); time-3, 4.4% (2.7, 6.3)). Women at high risk of fracture were identified by BMD (time-1, n = 231 (28.1%); time-2, n = 92 (16.0%); time-3, n = 51 (9.7%)) and FRAX criteria (time-1, n = 272 (33.1%); time-2, n = 105 (18.3%); time-3, n = 100 (19.0%)). The use of anti-fracture medication was low among these groups (BMD criteria: time-1, 1.7% (0.4, 3.7); time-2, 16.3% (8.7, 24.3); time-3, 15.7% (7.1, 26.1); FRAX criteria: time-1, 1.1% (0.0, 2.3); time-2, 18.1% (11.5, 25.5); time-3, 13.0% (6.5, 19.8)). CONCLUSION Use of anti-fracture medication among women at risk of fracture remained low over time. Investment into systems approaches to correct the treatment gap is warranted.
Collapse
Affiliation(s)
- Amanda L Stuart
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
| | - Julie A Pasco
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia.,University Hospital Geelong, Geelong, Australia
| | | | - Mark A Kotowicz
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.,Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia.,University Hospital Geelong, Geelong, Australia
| | - Kara L Holloway-Kew
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Sarah M Hosking
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Lana J Williams
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| |
Collapse
|
20
|
Hawarden A, Jinks C, Mahmood W, Bullock L, Blackburn S, Gwilym S, Paskins Z. Public priorities for osteoporosis and fracture research: results from a focus group study. Arch Osteoporos 2020; 15:89. [PMID: 32548718 PMCID: PMC7297850 DOI: 10.1007/s11657-020-00766-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Four focus groups were conducted with members of the public to identify important areas for future osteoporosis research. Participants identified priorities to increase public awareness of osteoporosis, reduce delays in diagnosis, improve communication between healthcare providers and to improve follow-up and information provision about causes of osteoporosis, medication harms and prognosis. PURPOSE Patients and the public must be involved in setting research agendas to ensure relevant and impactful questions are prioritised. This study aimed to understand what people living with osteoporosis and fragility fractures felt was important to research, to inform the content of a national survey on research priorities in this area. METHODS Focus groups were conducted with members of the public with experience of osteoporosis or fragility fractures. The topic guide was co-developed with a patient and public involvement research user group, and explored participants' experiences of osteoporosis including diagnosis, management and effect upon their lives, what aspects of their ongoing care was most important to them and what about their care or condition could be improved. Focus groups were audio-recorded, transcribed and analysed thematically. RESULTS A total of twenty-three participants were recruited to four focus groups. Analysis identified two main themes: challenges in living with osteoporosis and healthcare services for osteoporosis. Information needs was a further cross-cutting theme. Participants called for increased public awareness of osteoporosis and wanted healthcare services to address conflicting messages about diet, exercise and medication. Participants described long delays in diagnosis, poor communication between primary and secondary care and the need for structured follow-up as important areas for future research to address. CONCLUSION The findings from this study provide an understanding of research priorities from the perspective of patients and the public, have informed the content of a national survey and have implications for patient education, health services research and policy.
Collapse
Affiliation(s)
- Ashley Hawarden
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK ,grid.500956.fHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG UK
| | - Clare Jinks
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Waheed Mahmood
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Laurna Bullock
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Steven Blackburn
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK
| | - Stephen Gwilym
- grid.4991.50000 0004 1936 8948Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zoe Paskins
- grid.9757.c0000 0004 0415 6205Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, ST5 5BG UK ,grid.500956.fHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG UK
| |
Collapse
|
21
|
Osteoporosis prevention: Where are the barriers to improvement in French general practitioners? A qualitative study. PLoS One 2019; 14:e0219681. [PMID: 31310619 PMCID: PMC6634405 DOI: 10.1371/journal.pone.0219681] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Osteoporosis prevention, diagnosis and treatment remain suboptimal. Objectives We conducted a qualitative study to understand barriers towards care initiation and levers to improve awareness and management of osteoporosis among general practitioners (GPs). Methods Semi-structured face-to face interviews were conducted with 16 GPs in the Rhône area of France to explore their knowledge and representations regarding osteoporosis. A thematic analysis of transcripts was performed to identify GPs’ perceptions on osteoporosis diagnosis, prevention, treatment and patients’ expectations. Results Interviewed GPs considered osteoporosis far less important than other chronic diseases. They questioned whether osteoporosis was a disease or normal aspect of ageing. They associated osteoporosis with fragility fractures, female sex, menopause, and old age but rarely with male sex. They regarded bone mineral density as the reference diagnostic test, but certain GPs indicated that they had difficulties to interpret the results and to know when to prescribe. Biphosphonates were mentioned as the reference treatment but some GPs expressed distrust about osteoporosis medications. Most of them did not think to screen for osteoporosis risk factors in their patients in a preventive medical approach. They mentioned the lack of time to implement prevention and were expecting clear and pragmatic guidelines, as well as information campaigns in general population to increase awareness on osteoporosis. Conclusion GPs tended to underestimate the salience of osteoporosis. Clear recommendations, better awareness of GPs and the general population could improve osteoporosis prevention and treatment.
Collapse
|
22
|
Briggs AM, Hinman RS, Darlow B, Bennell KL, Leech M, Pizzari T, Greig AM, MacKay C, Bendrups A, Larmer PJ, Francis-Cracknell A, Houlding E, Desmond LA, Jordan JE, Minaee N, Slater H. Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study. ACR Open Rheumatol 2019; 1:219-235. [PMID: 31777798 PMCID: PMC6857979 DOI: 10.1002/acr2.1032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care. Methods Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high- and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses). Results A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data. Conclusion Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.
Collapse
Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Rana S Hinman
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice University of Otago Wellington New Zealand
| | - Kim L Bennell
- Department of Physiotherapy University of Melbourne Melbourne Australia
| | - Michelle Leech
- Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre La Trobe University Melbourne Australia
| | - Alison M Greig
- Department of Physical Therapy University of British Columbia Vancouver Canada
| | - Crystal MacKay
- Toronto Rehabilitation Institute University Health Network Toronto Canada
| | - Andrea Bendrups
- Department of Medicine (Royal Melbourne Hospital) University of Melbourne Melbourne Australia
| | - Peter J Larmer
- School of Clinical Sciences Auckland University of Technology Auckland New Zealand
| | | | - Elizabeth Houlding
- School of Physiotherapy and Exercise Science Curtin University Perth Australia.,Faculty of Science University of Ottawa Ottawa Canada
| | - Lucy A Desmond
- Department of Medicine Western Health Melbourne Australia
| | | | - Novia Minaee
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| | - Helen Slater
- School of Physiotherapy and Exercise Science Curtin University Perth Australia
| |
Collapse
|
23
|
Salminen H, Piispanen P, Toth-Pal E. Primary care physicians' views on osteoporosis management: a qualitative study. Arch Osteoporos 2019; 14:48. [PMID: 31028556 PMCID: PMC6486622 DOI: 10.1007/s11657-019-0599-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/14/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis is an under-diagnosed condition; only around 14% of patients in Sweden receive bone-specific treatment after a fragility fracture. This qualitative interview study found that primary care physicians perceive osteoporosis as a silent disease that is overshadowed by other conditions and is complicated to manage. PURPOSE To explore primary care physicians' views on managing osteoporosis. METHODS A total of 17 primary care physicians in Stockholm participated in four focus group interviews. Interview transcripts were analysed with thematic analysis. RESULTS One main theme was found: Osteoporosis-a silent disease overshadowed by other conditions. The main theme contained five sub-themes. Physicians perceived osteoporosis as a low-priority issue. They described uncertainty about managing it and insufficient awareness of the condition in primary healthcare (PHC). Physicians had differing opinions about who is responsible for managing osteoporosis. They reported that the health care system regulated their work such that they gave low priority to the condition. They were uncertain about the value of the Fracture Risk Assessment Tool (FRAX). The physicians thought that financial incentives, education, and increased collaboration with other relevant health care professionals and with patients were needed to increase the priority of osteoporosis in PHC. CONCLUSION Physicians perceived osteoporosis as a silent disease that is complicated to manage. They gave low priority to osteoporosis and thought their patients shared this view. The physicians saw other issues and medical conditions as more important than osteoporosis. They wanted better collaboration at their PHC centres and with hospitals. They also wanted district nurses to be more involved in managing osteoporosis and especially in assessing fracture risk.
Collapse
Affiliation(s)
- Helena Salminen
- 0000 0004 1937 0626grid.4714.6Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ,Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - P. Piispanen
- Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| | - E. Toth-Pal
- 0000 0004 1937 0626grid.4714.6Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ,Academic Primary Healthcare Centre, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
24
|
Alghamdi MA, Mohammed AGA. Knowledge and Awareness of Osteoporosis among Saudi Physicians and Nurses: A Cross-Sectional Study. Open Access Maced J Med Sci 2018; 6:913-916. [PMID: 29875871 PMCID: PMC5985884 DOI: 10.3889/oamjms.2018.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 11/24/2022] Open
Abstract
AIM: We aimed to evaluate the awareness and knowledge of osteoporosis in a sample of 141 health professionals. MATERIALS AND METHODS: A group of 141 health professionals (medical, surgical, primary health care and nursing departments) were enrolled in this cross-sectional study in the period from August 2017 to November 2017. The participants completed a questionnaire composed of 19 questions about osteoporosis which covering the main domains of knowledge on osteoporosis. Each correct answer carried 1 point whereas incorrect or ‘don’t know’ carried 0 points. This gave a total score range of 0-19. A cut-off level of < 10 points was considered as poor knowledge while ≥ 10 was regarded as good knowledge. RESULTS: Out of 141 respondents, 78 were females, 63 males, mean age of the participants was 38.17 ± 9.6 years, less than 40 years (n = 89), more than 40 years (n = 52). Nurses (n = 54), medical (n = 29), surgical (n = 35), primary health care (n = 23). Most of the study group with experience of fewer than 10 years (n = 66), 127 (90.1%) had good knowledge and 14 (9.9%) had poor knowledge p-value < 0.01. CONCLUSION: Our study revealed that Saudi health professionals have a good of knowledge about osteoporosis and no significant difference in osteoporosis knowledge between the health professional subgroups.
Collapse
Affiliation(s)
| | - Abdel Gaffar AbdelAllah Mohammed
- Division of Rheumatology, Department of Medicine, J 47 Old Main Building, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, South Africa
| |
Collapse
|
25
|
Hosking SM, Brennan-Olsen SL, Beauchamp A, Buchbinder R, Williams LJ, Pasco JA. Health literacy and uptake of anti-fracture medications in a population-based sample of Australian women. Res Social Adm Pharm 2018; 14:846-850. [PMID: 29778345 DOI: 10.1016/j.sapharm.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
This study investigated associations between health literacy and use of anti-fracture medications in women with osteoporosis. Data were collected for women participating in the population-based Geelong Osteoporosis Study in Australia. Health literacy was ascertained using the Health Literacy Questionnaire (HLQ) and bone mineral density by dual x-ray absorptiometry. Self-reported current medications were classified using MIMS codes, with the category 'Agent affecting calcium and bone metabolism' indicating osteoporosis treatment. Analysis of Variance (p-value <0.1 indicating a trend) and Cohen's d effect sizes (ES [95%CI]) (categorised; Small >0.2-<0.5, Moderate >0.5-0.8, Large >0.8) were calculated for differences in HLQ scale scores between participants who did vs. did not self-report medication use. Among 620 women, 134 (21.6%) had osteoporosis, 14 (10.5%) of whom self-reported current anti-fracture medication use. Small/moderate ES indicated women taking medication had lower HLQ scores in scales 'Navigating the healthcare system', 'Ability to find health information' and 'Understand health information' (ES 0.36 [0.25-0.79], 0.41 [0.29-0.87] and 0.64 [0.54-1.03], respectively). A trend was observed (p = 0.09) for 'Understand health information' scale scores and utilisation of medication. These data suggest women with less confidence in their ability to find and understand health information may follow healthcare provider recommendations and utilise anti-fracture medications more readily.
Collapse
Affiliation(s)
- Sarah M Hosking
- Deakin University, Geelong, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - Sharon L Brennan-Olsen
- Deakin University, Geelong, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia; Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia; Australian Health Policy Collaboration, Melbourne, VIC, Australia.
| | - Alison Beauchamp
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia; Department of Rural Health, Monash University, Moe, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, VIC, Australia.
| | | | - Julie A Pasco
- Deakin University, Geelong, VIC, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
26
|
Do reductions in out-of-pocket expenses for dual energy X-ray absorptiometry scans translate to reduced fracture incidence amongst older Australians? A population-based study. Arch Osteoporos 2018; 13:41. [PMID: 29656305 DOI: 10.1007/s11657-018-0449-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/23/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study aimed to compare fracture incidence in the elderly pre- and post-revision of bone density scan reimbursement guidelines, which changed in 2007. Fracture incidence by age group was calculated using population-specific data. Guideline changes did not appear to reduce fracture incidence in the study region located in south-eastern Australia. PURPOSE In 2007, Medicare Australia revised reimbursement guidelines whereby individuals aged 70 years and over received reduced out-of-pocket expenses for dual energy X-ray absorptiometry (DXA) scans. The current study aims to determine whether fracture incidence in the elderly has changed since the revision of reimbursement guidelines. METHOD Keyword searches of the two major radiological centres servicing the Barwon Statistical Division (BSD) were used to identify incident fractures for residents aged 75 years and over for 2006 and 2012. Pathological fractures were excluded. Fracture incidence by age strata (75-79 years, 80-84 years and 85+ years) were calculated using population-specific data from the Australian Bureau of Statistics (2006 and 2012). Standardised fracture ratios were calculated for men and women. RESULTS In total, 996 fracture events were identified for BSD residents during 2006 and 1260 identified in 2012. The standardised fracture ratios between 2006 and 2012 were 1.12 (95%CI 1.11, 1.25) for men and 1.08 (95%CI 1.11, 1.16) for women. CONCLUSION The change in reimbursement guidelines appears to have had little impact on reducing fracture incidence during this time frame for elderly men and women, in fact, fracture rates increased. Future research should investigate osteoporosis management following DXA over a longer time frame.
Collapse
|
27
|
Raybould G, Babatunde O, Evans AL, Jordan JL, Paskins Z. Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review. Arch Osteoporos 2018; 13:55. [PMID: 29736627 PMCID: PMC5938310 DOI: 10.1007/s11657-018-0470-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED This systematic review identified patients have unmet information needs about the nature of osteoporosis, medication, self-management and follow-up. Clinician knowledge and attitudes appear to be of key importance in determining whether these needs are met. Unmet information needs appear to have psychosocial consequences and result in poor treatment adherence. PURPOSE Patient education is an integral component of the management of osteoporosis, yet patients are dissatisfied with the information they receive and see this as an area of research priority. This study aimed to describe and summarise the specific expressed information needs of patients in previously published qualitative research. METHODS Using terms relating to osteoporosis, fragility fracture and information needs, seven databases were searched. Articles were screened using predefined inclusion and exclusion criteria. Full-text articles selected for inclusion underwent data extraction and quality appraisal. Findings were drawn together using narrative synthesis. RESULTS The search identified 11,024 articles. Sixteen empirical studies were included in the review. Thematic analysis revealed three overarching themes relating to specific information needs, factors influencing whether information needs are met and the impact of unmet information needs. Specific information needs identified included the following: the nature of osteoporosis/fracture risk; medication; self-management and understanding the role of dual energy x-ray absorptiometry and follow-up. Perceived physician knowledge and attitudes, and the attitudes, beliefs and behaviours of patients were important factors in influencing whether information needs were met, in addition to contextual factors and the format of educational resources. Failure to elicit and address information needs appears to be associated with poor treatment adherence, deterioration of the doctor-patient relationship and important psychosocial consequences. CONCLUSION This is the first study to describe the information needs of patients with osteoporosis and fracture, the impact of this information gap and possible solutions. Further research is needed to co-design and evaluate educational interventions with patients.
Collapse
Affiliation(s)
- Grace Raybould
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Science, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Opeyemi Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Science, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Amy L. Evans
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Science, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Science, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Science, Keele University, Keele, Staffordshire ST5 5BG UK ,Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, ST6 7AG UK
| |
Collapse
|
28
|
Tan EK, Loh KP, Goff SL. Internal Medicine Hospitalists' Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures. South Med J 2017; 110:749-753. [PMID: 29197305 DOI: 10.14423/smj.0000000000000735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. METHODS In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center. The interviews were analyzed with directed content analysis. RESULTS Internal medicine hospitalists consider secondary osteoporotic hip fracture prevention as the responsibility of outpatient physicians. Identified barriers were stratified based on themes including physicians' perception, patients' characteristics, risks and benefits of osteoporosis treatment, healthcare delivery system, and patient care transition from the inpatient to the outpatient setting. Some of the recommendations include building an integrated system that involves a multidisciplinary team such as the fracture liaison service, initiating a change to the hospital policy to facilitate inpatient care and management of osteoporosis, and creating a smooth patient care transition to the outpatient setting. CONCLUSIONS Our study highlighted how internal medicine hospitalists perceive their role in the secondary prevention of osteoporotic hip fractures and what they perceive as barriers to initiating preventive measures in the hospital. Inconsistency in patient care transition and the fragmented nature of the existing healthcare system were identified as major barriers. A fracture liaison service could remove some of these barriers.
Collapse
Affiliation(s)
- Eng Keong Tan
- From the Department of Endocrinology, Diabetes and Metabolism Research Institute, City of Hope National Medical Center, Duarte, California, the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York, and the Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
| | - Kah Poh Loh
- From the Department of Endocrinology, Diabetes and Metabolism Research Institute, City of Hope National Medical Center, Duarte, California, the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York, and the Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
| | - Sarah L Goff
- From the Department of Endocrinology, Diabetes and Metabolism Research Institute, City of Hope National Medical Center, Duarte, California, the Division of Hematology/Oncology, James P. Wilmot Cancer Institute, University of Rochester/Strong Memorial Hospital, Rochester, New York, and the Department of Medicine, Tufts University School of Medicine, Springfield, Massachusetts
| |
Collapse
|
29
|
Chou L, Shamdasani P, Briggs AM, Cicuttini FM, Sullivan K, Seneviwickrama KLMD, Wluka AE. Systematic scoping review of patients' perceived needs of health services for osteoporosis. Osteoporos Int 2017; 28:3077-3098. [PMID: 28762126 DOI: 10.1007/s00198-017-4167-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/17/2017] [Indexed: 01/04/2023]
Abstract
Health service planners, administrators and providers need to understand the patients' perspective of health services related to osteoporosis to optimise health outcomes. The aims of this study were to systematically identify and review the literature regarding patients' perceived health service needs relating to osteoporosis and osteopenia. A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoporosis health services were categorised. Thirty-three studies (19 quantitative and 14 qualitative) from 1027 were relevant. The following areas of perceived need emerged: (1) patients sought healthcare from doctors to obtain information and initiate management. They were dissatisfied with poor communication, lack of time and poor continuity of care. (2) Patients perceived a role for osteoporosis pharmacotherapy but were concerned about medication administration and adverse effects. (3) Patients believed that exercise and vitamin supplementation were important, but there is a lack of data examining the needs for other non-pharmacological measures such as smoking cessation and alcohol. (4) Patients wanted diagnostic evaluation and ongoing surveillance of their bone health. This review identified patients' needs for better communication with their healthcare providers. It also showed that a number of important cornerstones of therapy for osteoporosis, such as pharmacotherapy and exercise, are identified as important by patients, as well as ongoing surveillance of bone health. Understanding patients' perceived needs and aligning them with responsive and evidence-informed service models are likely to optimise patient outcomes.
Collapse
Affiliation(s)
- L Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia
| | - P Shamdasani
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia
| | - A M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
- Move: Muscle, Bone and Joint Health, Melbourne, Victoria, Australia
| | - F M Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia
| | - K Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - K L M D Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia
| | - A E Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Commercial Road, Melbourne, Victoria, Australia.
| |
Collapse
|
30
|
Vytrisalova M, Touskova T, Fuksa L, Karascak R, Palicka V, Byma S, Stepan J. How General Practitioners and Their Patients Adhere to Osteoporosis Management: A Follow-Up Survey among Czech General Practitioners. Front Pharmacol 2017; 8:258. [PMID: 28553228 PMCID: PMC5425585 DOI: 10.3389/fphar.2017.00258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/25/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction: General practitioners (GPs) are key participants in osteoporosis (OP) management. The aim was to evaluate their adherence to lege artis management of the disease, potential barriers, and to discuss differences observed in comparison with the baseline survey carried out in 2007; the focus was on secondary prevention. Methods: On behalf of two professional associations, 2-round postal survey among randomly selected GPs (>1/4 of all Czech GPs) was performed in 2014. The questionnaire covered areas concerning GP's role in the fight against OP, knowledge about OP, management of OP-related fractures, barriers to the management of OP, system- and patient-related in particular, and availability and use of information sources. Results: The overall questionnaire return rate was 37% (551 respondents); mean age of the respondents was 53 year (37% men). The GP's role in the treatment of OP was rated as essential in 28 and 37% of men and women, respectively (P = 0.012). The guideline for diagnosis and treatment of OP for GPs was considered accessible by 92% of respondents. As much as 60% of the respondents were adherent to the guideline, i.e., used it repeatedly. The knowledge of several risk factors was very good, however, recommended daily intake of calcium was stated correctly by only 41% of respondents, and daily intake of vitamin D by only 40%. Three quarters reported active steps after a fracture: referral to a specialist, life-style recommendations, prescription of calcium/vitamin D supplements. Half of the respondents focus on fall prevention. System-related barriers, such as lack of possibility to prescribe selected drugs (61%) and financial limits set by health insurance company (44%) were most frequently reported. Patient-related barriers were also common, patient's non-adherence (reported by 29%) and patient's reluctance to go to a specialist (18%). Conclusion: GPs adhered to OP management more than in 2007. Knowledge of risk factors and involvement in post-fracture care was relatively high. Compared to baseline survey, patient-related barriers, patient non-adherence in particular, were more common. Prescribing conditions are still an important issue. Among GPs, education should be focused on calcium and vitamin D intake, doses, sources, and supplements.
Collapse
Affiliation(s)
- Magda Vytrisalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles UniversityHradec Kralove, Czechia
| | - Tereza Touskova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles UniversityHradec Kralove, Czechia
| | - Leos Fuksa
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles UniversityHradec Kralove, Czechia
| | - Roman Karascak
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles UniversityHradec Kralove, Czechia
| | - Vladimir Palicka
- Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove and University Hospital Hradec KraloveHradec Kralove, Czechia
| | - Svatopluk Byma
- Department of Social Medicine, Faculty of Medicine in Hradec Kralove, Charles UniversityHradec Kralove, Czechia
| | - Jan Stepan
- Department of Rheumatology, Faculty of Medicine, Institute of Rheumatology, Charles UniversityPrague, Czechia
| |
Collapse
|
31
|
Fogelman Y, Goldshtein I, Segal E, Ish-Shalom S. Managing Osteoporosis: A Survey of Knowledge, Attitudes and Practices among Primary Care Physicians in Israel. PLoS One 2016; 11:e0160661. [PMID: 27494284 PMCID: PMC4975485 DOI: 10.1371/journal.pone.0160661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Osteoporosis is a systemic skeletal disorder characterized by impaired bone quality and microstructural deterioration leading to an increased propensity to fractures. This is a major health problem for older adults, which comprise an increasingly greater proportion of the general population. Due to a large number of patients and the insufficient availability of specialists in Israel and worldwide, osteoporosis is treated in large part by primary care physicians. We assessed the knowledge of primary care physicians on the diagnosis and treatment of osteoporosis. METHODS Physician's knowledge, sources of knowledge acquisition and self-evaluation of knowledge were assessed using a multiple choice questionnaire. Professional and demographic characteristics were assessed as well. RESULTS Of 490 physicians attending a conference, 363 filled the questionnaires (74% response rate). The physicians demonstrated better expertise in diagnosis than in medications (mechanism of action, side effects or contra-indications) but less than for other treatment related decisions. Overall, 50% demonstrated adequate knowledge of calcium and vitamin D supplementation, 51% were aware of the main therapeutic purpose of osteoporosis pharmacotherapy and 3% were aware that bisphosphonates should be avoided in patients with impaired renal function. Respondents stated frontal lectures at meetings as their main source of information on the subject. CONCLUSION The study indicates the need to intensify efforts to improve the knowledge of primary care physicians regarding osteoporosis, in general; and osteoporosis pharmacotherapy, in particular.
Collapse
Affiliation(s)
- Yacov Fogelman
- Department of Family Practice, Leumit Health Services Tel aviv, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Inbal Goldshtein
- Epidemiology and Database Research, Maccabi Healthcare Services, Tel-Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Elena Segal
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Endocrinology, Rambam Health Care Campus, Haifa, Israel
| | | |
Collapse
|
32
|
Brennan-Olsen SL, Hosking SM, Dobbins AG, Pasco JA. Translating Osteoporosis Prevention Guidelines. J Aging Health 2016; 29:531-545. [PMID: 27056908 DOI: 10.1177/0898264316641076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In Australia, the social gradient of chronic disease has never been as prominent as in current times, and the uptake of preventive health messages appears to be lower in discrete population groups. In efforts to re-frame health promotion from addressing behavior change to empowerment, we engaged community groups in disadvantaged neighborhoods to translate published preventive guidelines into easy-to-understand messages for the general population. METHOD Our research team established partnerships with older aged community groups located in disadvantaged neighborhoods, determined by cross-referencing addresses with the Australian Bureau of Statistics, to translate guidelines regarding osteoporosis prevention. RESULTS We developed an oversized jigsaw puzzle that we used to translate recommended osteoporosis prevention guidelines. DISCUSSION Successful participatory partnerships between researchers, health promotion professionals, and community groups in disadvantaged neighborhoods build capacity in researchers to undertake future participatory processes; they also make the best use of expert knowledge held by specific communities.
Collapse
Affiliation(s)
- Sharon L Brennan-Olsen
- 1 Deakin University, Geelong, Victoria, Australia.,2 Barwon Health, Geelong, Victoria, Australia.,3 The University of Melbourne, St. Albans, Victoria, Australia
| | - Sarah M Hosking
- 1 Deakin University, Geelong, Victoria, Australia.,2 Barwon Health, Geelong, Victoria, Australia
| | - Amelia G Dobbins
- 1 Deakin University, Geelong, Victoria, Australia.,2 Barwon Health, Geelong, Victoria, Australia
| | - Julie A Pasco
- 1 Deakin University, Geelong, Victoria, Australia.,2 Barwon Health, Geelong, Victoria, Australia.,3 The University of Melbourne, St. Albans, Victoria, Australia
| |
Collapse
|
33
|
Qualitative Insights from the Osteoporosis Research: A Narrative Review of the Literature. J Osteoporos 2016; 2016:7915041. [PMID: 27994908 PMCID: PMC5138461 DOI: 10.1155/2016/7915041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/16/2016] [Accepted: 10/16/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose. Much of the research on osteoporosis has been generated quantitatively. However, the qualitative osteoporosis literature provides valuable information on patient and clinician experiences and perspectives, informing the design and implementation of health research and healthcare services. To identify knowledge gaps and inform the design of future qualitative research, a narrative review was conducted to consolidate and synthesize the existing insights available within the qualitative osteoporosis research. Methods. Search terms reflecting the domains of osteoporosis and qualitative research were entered into the Scopus database to generate a comprehensive survey of qualitative research in the area of osteoporosis. Articles were thematically analysed and the results are presented in the form of a narrative review. Results. Forty-four articles were included in the narrative review. Qualitative research in the field of osteoporosis research can be summarized by 3 thematic areas: the meaning of osteoporosis for patients and the public, the lived experience of an osteoporosis diagnosis, and the programmatic approach to osteoporosis prevention and treatment. Conclusions. Qualitative studies provide clinically valuable insights in how osteoporosis is conceptualized and managed and programmatic aspects of osteoporosis treatment. The findings of this narrative review suggest the need for balance between presenting osteoporosis as a serious health condition and producing unwarranted anxiety and inactivity so as to ensure the best possible outcomes for individuals with osteoporosis.
Collapse
|
34
|
Claesson A, Toth-Pal E, Piispanen P, Salminen H. District nurses' perceptions of osteoporosis management: a qualitative study. Osteoporos Int 2015; 26:1911-8. [PMID: 25792490 DOI: 10.1007/s00198-015-3086-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/20/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. INTRODUCTION Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. METHODS Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. RESULTS The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. CONCLUSIONS Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.
Collapse
Affiliation(s)
- A Claesson
- Unit of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden,
| | | | | | | |
Collapse
|
35
|
Banakh I, Chao S. PRO-OSTEO Extend I study (improving osteoporosis management in the acute and rehabilitation settings): multicentre audit. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Iouri Banakh
- Pharmacy Department; Frankston Hospital; Frankston Victoria Australia
| | - Sarah Chao
- Aged and Palliative Care Services, Pharmacy Department; Golf Links Road Rehabilitation Centre; Frankston Victoria Australia
| |
Collapse
|
36
|
Hosking SM, Dobbins AG, Pasco JA, Brennan SL. Knowledge change regarding osteoporosis prevention: translating recommended guidelines into user-friendly messages within a community forum. BMC Res Notes 2015; 8:33. [PMID: 25881180 PMCID: PMC4326447 DOI: 10.1186/s13104-015-0985-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/15/2015] [Indexed: 11/14/2022] Open
Abstract
Background Osteoporosis is a skeletal disorder characterised by low bone mineral density and increased fracture risk. Nationally the total costs of this chronic disease are currently estimated at $2.754 billion annually. Effective public health messages providing clear recommendations are vital in supporting prevention efforts. This research aimed to investigate knowledge change associated with the translation of preventive guidelines into accessible messages for the community. Findings We delivered a community-based information session that translated recommended guidelines for osteoporosis prevention into lay terms; items focused on dietary calcium, vitamin D, physical activity, alcohol, smoking and general osteoporosis-related knowledge. We developed a 10-item questionnaire reflecting these key points (score range 0–10) and investigated knowledge change associated with the session. Pre- and post-test questionnaires were completed by 47 participants (51% female), aged 21–94 years. Relatively high pre-test scores were observed for questions regarding sedentary activity and calcium intake. The lowest pre-test scores were observed for the item concerning whether swimming and cycling strengthened bones, and the highest possible score post-test was achieved for three of the items: calcium-rich food as a protective factor, and excessive alcohol and smoking as risk factors. The overall increase in knowledge change was a mean score of +2.08 (95%CI 1.58–2.42). Conclusions An increase in knowledge regarding osteoporosis prevention was demonstrated over the short-term. Our findings suggest that the guidelines concerning dietary calcium are generally well understood; however, the asymptomatic nature of osteoporosis and the types of physical activity that assist with bone strength are less well understood.
Collapse
Affiliation(s)
- Sarah M Hosking
- Epi-Centre for Healthy Ageing, School of Medicine (Barwon Health), Deakin University, PO BOX 281, Geelong, VIC, Australia.
| | - Amelia G Dobbins
- Epi-Centre for Healthy Ageing, School of Medicine (Barwon Health), Deakin University, PO BOX 281, Geelong, VIC, Australia.
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, School of Medicine (Barwon Health), Deakin University, PO BOX 281, Geelong, VIC, Australia. .,NorthWest Academic Centre, Department of Medicine, the University of Melbourne, St Albans, VIC, Australia.
| | - Sharon L Brennan
- Epi-Centre for Healthy Ageing, School of Medicine (Barwon Health), Deakin University, PO BOX 281, Geelong, VIC, Australia. .,NorthWest Academic Centre, Department of Medicine, the University of Melbourne, St Albans, VIC, Australia.
| |
Collapse
|
37
|
Stuart AL, Williams LJ, Brennan SL, Kotowicz MA, Pasco JA. Poor agreement between self-reported diagnosis and bone mineral density results in the identification of osteoporosis. J Clin Densitom 2015; 18:13-6. [PMID: 24912958 DOI: 10.1016/j.jocd.2014.04.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
Osteoporosis is a major health concern, estimated to affect millions worldwide. Bone mineral density (BMD) assessment is not practical for many large-scale epidemiological studies resulting in the reliance of self-report methods to ascertain diagnostic information. The aim of the study was to assess the validity of self-reported diagnosis of osteoporosis in a population-based study. This study examined data collected from 906 men and 843 women participating in the Geelong Osteoporosis Study. Osteoporosis was self-reported and compared against results of BMD scans of the hip and spine. Validity was examined by calculating sensitivity, specificity, positive predictive value, negative predictive value, and kappa statistic. Osteoporosis was self-reported by 118 (6.7%) participants and identified using BMD results for 64 (3.7%) participants. Specificity and negative predictive value were good (95.1% and 96.0%, respectively), whereas sensitivity and positive predictive value were poor (35.9% and 31.4%, respectively). The overall level of agreement (kappa) was 0.29. The results changed only slightly when we included participants with osteopenia and adult fracture as osteoporotic. Reliance on self-report methods to ascertain osteoporosis status is not recommended.
Collapse
Affiliation(s)
| | - Lana J Williams
- School of Medicine, Deakin University, Geelong, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Sharon L Brennan
- School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, St Albans, Australia; Australian Institute for Musculoskeletal Sciences, St Albans, Australia
| | - Mark A Kotowicz
- School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, St Albans, Australia; Division of Medicine, Barwon Health, Geelong, Australia
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Australia; NorthWest Academic Centre, The University of Melbourne, Sunshine Hospital, St Albans, Australia; Division of Medicine, Barwon Health, Geelong, Australia
| |
Collapse
|
38
|
Improving osteoporosis management in general practice: a pharmacist-led drug use evaluation program. Drugs Aging 2014; 31:703-9. [PMID: 24993982 DOI: 10.1007/s40266-014-0194-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the impact of a drug use evaluation (DUE) program on osteoporosis management in general practice. METHODS A DUE program, led by pharmacists integrated into two general practice clinics in Melbourne, Australia, was undertaken as part of the Pharmacists in Practice Study. Data on use of anti-osteoporosis medicines and calcium and vitamin D supplements were collected at baseline and 12 months. Following the baseline audit, an intervention comprising prescriber feedback, group education and individual case-conferences with prescribers, and patient education mail-outs was implemented. The primary outcome was the proportion of patients with a diagnosis of osteoporosis and without contraindications to anti-osteoporosis medicines who were prescribed an anti-osteoporosis medicine. Feedback from practice staff and pharmacists was explored qualitatively to evaluate the acceptability of the program. RESULTS The proportion of patients without documented contraindications to osteoporosis therapies who were prescribed an anti-osteoporosis medicine increased significantly (134/227 [59.0 %] vs. 168/240 [70.0 %], p = 0.002). The proportion of patients for whom vitamin D and/or calcium supplement use was documented also increased significantly (145/227 [63.9 %] vs. 205/240 [85.4 %], p = 0.002). Practice staff and pharmacists were generally positive about the DUE program. CONCLUSIONS A practice pharmacist-led DUE program improved the management of osteoporosis in general practice.
Collapse
|
39
|
Slomian J, Appelboom G, Ethgen O, Reginster JY, Bruyère O. Can New Information and Communication Technologies Help in the Management of Osteoporosis? WOMENS HEALTH 2014; 10:229-32. [DOI: 10.2217/whe.14.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Justine Slomian
- Department of Public Health, Epidemiology & Health Economics, University of Liège, Belgium Support Unit in Epidemiology & Biostatistics, University of Liège, Belgium,
| | | | - Olivier Ethgen
- Department of Public Health, Epidemiology & Health Economics, University of Liège, Belgium
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology & Health Economics, University of Liège, Belgium and Support Unit in Epidemiology & Biostatistics, University of Liège, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology & Health Economics, University of Liège, Belgium and Support Unit in Epidemiology & Biostatistics, University of Liège, Belgium
| |
Collapse
|
40
|
Pasco JA, Lane SE, Brennan SL, Timney EN, Bucki-Smith G, Dobbins AG, Nicholson GC, Kotowicz MA. Fracture risk among older men: osteopenia and osteoporosis defined using cut-points derived from female versus male reference data. Osteoporos Int 2014; 25:857-62. [PMID: 24196721 DOI: 10.1007/s00198-013-2561-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
SUMMARY We explored the effect of using male and female reference data in a male sample to categorise areal bone mineral density (BMD). Using male reference data, a large proportion of fractures arose from osteopenia, whereas using female reference data shifted the fracture burden into normal BMD. INTRODUCTION The purpose of this study was to describe fracture risk associated with osteopenia and osteoporosis in older men, defined by areal BMD and using cut-points derived from male and female reference data. METHODS As part of the Geelong Osteoporosis Study, we followed 619 men aged 60-93 years after BMD assessments (performed 2001-2006) until 2010, fracture, death or emigration. Post-baseline fractures were radiologically confirmed, and proportions of fractures in each BMD category were age-standardised to national profiles. RESULTS Based on World Health Organization criteria, and using male reference data, 207 men had normal BMD at the femoral neck, 357 were osteopenic and 55 were osteoporotic. Using female reference data, corresponding numbers were 361, 227 and 31. During the study, 130 men died, 15 emigrated and 63 sustained at least one fracture. Using male reference data, most (86.5 %) of the fractures occurred in men without osteoporosis on BMD criteria (18.4 % normal BMD, 68.1 % osteopenia). The pattern differed when female reference data were used; while most fractures arose from men without osteoporosis (88.2 %), the burden shifted from those with osteopenia (34.8 %) to those with normal BMD (53.4 %). CONCLUSIONS Decreasing BMD categories defined increasing risk of fracture. Although men with osteoporotic BMD were at greatest risk, they made a relatively small contribution to the total burden of fractures. Using male reference data, two-thirds of the fractures arose from men with osteopenia. However, using female reference data, approximately half of the fractures arose from those with normal BMD. Using female reference data to define osteoporosis in men does not appear to be the optimal approach.
Collapse
Affiliation(s)
- J A Pasco
- School of Medicine, Deakin University, Geelong, Australia,
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia. Arch Osteoporos 2013; 8:152. [PMID: 24072727 DOI: 10.1007/s11657-013-0152-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/06/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED In 2007, Medicare Australia revised rei:mbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low. INTRODUCTION On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division. METHODS Proportions of DXA referrals 2003-2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men). RESULTS DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003-2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007-2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70-79 years (p < 0.001), 1:1.2 for men aged 80-84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70-79 years), 1.1.5 (80-84 years), and 1:1.4 (85+ years) (all p < 0.001). CONCLUSIONS DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007-2010 vs. 2003-2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.
Collapse
|
42
|
Markanday S, Brennan SL, Gould H, Pasco JA. Sex-differences in reasons for non-participation at recruitment: Geelong Osteoporosis Study. BMC Res Notes 2013; 6:104. [PMID: 23506528 PMCID: PMC3606438 DOI: 10.1186/1756-0500-6-104] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/11/2013] [Indexed: 11/24/2022] Open
Abstract
Background Understanding reasons for non-participation in health studies can help guide recruitment strategies and inform researchers about potential sources of bias in their study sample. Whilst there is a paucity of literature regarding this issue, it remains highly plausible that men and women may have varied reasons for declining an invitation to participate in research. We aimed to investigate sex-differences in the reasons for non-participation at baseline of the Geelong Osteoporosis Study (GOS). Methods The GOS, a prospective cohort study, randomly recruited men and women aged 20 years and over from a region in south-eastern Australia using Commonwealth electoral rolls (2001–06 and 1993–97, respectively). Reasons for non-participation (n=1,200) were documented during the two recruitment periods. We used the Pearson’s chi squared test to explore differences in the reasons for non-participation between men and women. Results Non-participation in the male cohort was greater than in the female cohort (32.9% vs. 22.9%; p<0.001). Overall, there were sex-differences in the reasons provided for non-participation (p<0.001); apparent differences related to time constraints (men 26.3% vs. women 10.4%), frailty/inability to cope with or understand the study (men 18.7% vs. women 30.6%), and reluctance over medical testing (men 1.1% vs women 9.9%). No sex-differences were observed for non-participation related to personal reason/disinterest, and language- or travel-related reasons. Conclusions Improving participation rates in epidemiological studies may require different recruitment strategies for men and women in order to address sex-specific concerns about participating in research.
Collapse
Affiliation(s)
- Shikha Markanday
- Department of Medicine, Barwon Health, Geelong, VIC, 3220, Australia
| | | | | | | |
Collapse
|