, Volume 19, Issue 11, pp 1527-1540
Date: 29 Mar 2008

Harnessing stakeholder perspectives to improve the care of osteoporosis after a fracture

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Abstract

Summary

This study used in-depth interviews and focus groups to evaluate osteoporosis care after a fracture. Patients (eligible women aged 67 who sustained a clinical fracture(s)), clinicians, and staff stated that an outreach program facilitated osteoporosis care management, but more-tailored education and support and increased participation of orthopedic specialists appear necessary.

Introduction

Osteoporosis treatment reduces fracture risk, but screening and treatment are underutilized, even after a fracture has occurred. This study evaluated key stakeholder perspectives about the care of osteoporosis after a fracture.

Methods

Participants were from a nonprofit health maintenance organization in the United States: eligible women members aged 67 or older who sustained a clinical fracture(s) (n = 10), quality and other health care managers (n = 20), primary care providers (n = 9), and orthopedic clinicians and staff (n = 28); total n = 67. In-depth interviews and focus groups elicited participant perspectives on an outreach program to patients and clinicians and other facilitators and barriers to care. Interviews and focus group sessions were transcribed and content-analyzed.

Results

Patients, clinicians, and staff stated that outreach facilitated osteoporosis care management, but important patient barriers remained. Patient knowledge gaps and fatalism were common. Providers stated that management needed to begin earlier, and longer-term patient support was necessary to address adherence. Orthopedic clinicians and staff expressed lack of confidence in their osteoporosis management but willingness to encourage treatment.

Conclusions

Although an outreach program assisted with the management of osteoporosis after a fracture, more-tailored education and support and increased participation of orthopedic specialists appear necessary to maximize osteoporosis management.

Disclaimers: This study was supported in part by a research contract from Merck & Co., Inc. The sponsor had no role in the study design, methods, subject recruitment, data collection, analysis, or preparation of the paper.
Dr. Feldstein has received research grant support from Merck & Co, Inc.; Amgen; and Sanofi-Aventis. Dr. Vollmer has served on ad hoc advisory boards for Merck and Co., Inc., and is director of the Burden of Obstructive Lung Disease (BOLD) Operations Center, funding for which includes unrestricted educational grants to his employer, the Center for Health Research, Kaiser Permanente Northwest, from Boehringer Ingelheim, Pfizer, ALTANA, GlaxoSmithKline, AstraZeneca, Novartis, Chiesi, and Merck. Dr. Smith has received research grant support from Sanofi-Aventis, Abbot, Amgen, and Genzyme.