Poster Presentation ESA-SRB-APEG-NZSE 2022

PATIENT AND PRACTITIONER EXPERIENCES OF POST-FRACTURE CARE AT THE TERTIARY-PRIMARY CARE INTERFACE: A QUALITATIVE STUDY (#281)

Michael J Bennett 1 , Lin Perry 2 , Jackie Center 3
  1. University of New South Wales, Sydney, NSW, Australia
  2. School of Nursing and Midwifery, University of Technology, Sydney, NSW, Australia
  3. Clinical Studies and Epidemiology Lab, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia

AIM

Whilst Osteoporosis Refracture Prevention (ORP) services are an effective model for secondary fracture prevention (1), adherence to long-term therapies remains suboptimal (1-3). The need to improve coordination between tertiary and primary post-fracture care is increasingly recognised (4-7). This study aims to map current service processes and factors influencing integration of post-clinic care, and identify barriers and supports for seamless healthcare.

 

METHODS

This qualitative descriptive study used semi-structured interviews with multiple stakeholders at two metropolitan hospitals in NSW and surrounding general practices, recruiting until data saturation. Interview transcripts were analysed for emergent themes. A concept map was developed to describe thematic relationships.  

 

RESULTS

Seven ORP clinicians, 11 GPs, and seven patients were interviewed. Six key themes were found to affect the transition of patient care from tertiary to primary care (PC): interprofessional communication issues and role ambiguity posed the greatest threat to seamless post-fracture care. Delayed, absent, inaccessible, or poor-quality communication was a frequent source of frustration for healthcare professionals. ORP clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. While GPs were confident and sought a greater role in osteoporosis management, ORP clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. For PC follow-up to occur, patients required both a strong GP-patient relationship and a perceived need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and behaviours) affected their PC attendance. Limited public awareness of osteoporosis and healthcare policy prioritisation were also seen to contribute to care gaps in the pre- and post-ORP clinic landscape.

 

CONCLUSION

This study identified key challenges facing stakeholders seeking to improving post-clinic osteoporosis care. Local policies and care pathways are suggested to address information and service delivery issues across the acute-to-primary care divide.

 

 

 

 

 

  1. Wu CH, Tu ST, Chang YF, et al. Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone. 2018;111:92-100.
  2. Mugnier B, Daumas A, Doddoli S, et al. Adherence to fracture liaison service programs in patients over 70: the hidden part of the iceberg. Osteoporosis International. 2020:1-10.
  3. Hiligsmann M, Cornelissen D, Vrijens B, et al. Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF). Osteoporosis International. 2019;30(11):2155-2165.
  4. Royal College of Physicians. Fracture liaison service database annual report. 2020. https://www.rcplondon.ac.uk/projects/outputs/fls-database-annual-report-2020. Accessed 19 July 2022.
  5. Chandran M. Fracture Liaison Services in an open system: how was it done? what were the barriers and how were they overcome? Current osteoporosis reports. 2013;11(4):385-390.
  6. Hawarden A, Jinks C, Mahmood W, et al. Public priorities for osteoporosis and fracture research: results from a focus group study. Archives of Osteoporosis. 2020;15(1) (no pagination).
  7. Healthy Bones Australia. Position Statement on Improving Bone Health and Osteoporosis Management in Australia. 2021. https://healthybonesaustralia.org.au/wp-content/uploads/2021/05/HBA-Community-Forum-Position-Statement-WEB-30-04-21.pdf. Accessed 19 July 2022.