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Patient perceptions of provider barriers to post-fracture secondary prevention

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Abstract

Summary

We examined patients’ experiences regarding bone mineral density (BMD) testing and bone health treatment after being screened through Ontario’s Fracture Clinic Screening Program. Provider-level barriers to testing and treatment appeared to be as significant as patient-level barriers and potentially had more of an impact on treatment than on testing.

Introduction

Post-fracture secondary prevention programs have had modest effects on bone densitometry rates and osteoporosis (OP) treatment initiation. Few studies have examined in depth the reasons that patients choose to seek or avoid investigation and treatment after screening through such a program. Our purpose was to examine patients’ experiences regarding bone mineral density (BMD) testing and bone health treatment after screening through Ontario’s Fracture Clinic Screening Program (FCSP).

Methods

We conducted a prospective qualitative study in fragility fracture patients screened through one site of the FCSP. Eligible patients not on antiresorptive medication at the time of fracture were assessed by an osteoporosis screening coordinator and advised to follow up with their primary care physician for a BMD test and appropriate treatment. Participants were interviewed within 6, and within 18, months of their clinic visit. Fracture risk was assessed by the study team. Interviews were transcribed verbatim and analyzed by two researchers.

Results

We conducted 51 interviews with 25 patients (22 females, 3 males) aged 50–79 years old, of whom 8 were deemed high risk for future fracture. Eighteen participants had a BMD test between baseline and follow-up and three reported receiving a prescription for pharmacotherapy. We categorized 21 participants as experiencing at least one barrier to BMD testing and appropriate treatment including health care providers telling participants that the fracture was not a fragility fracture, using participants’ appearance/demographic information and X-rays to judge bone density, telling participants that a BMD test was not appropriate, failing to discuss fracture risk status, and giving unclear or incorrect information about treatment.

Conclusion

We identified modifiable barriers to post-fracture secondary prevention from the patient’s perspective. Provider-level barriers appeare to be as significant as patient-level barriers and potentially had more of an impact on treatment than on BMD testing.

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Acknowledgments

Funding for this project was provided by the Canadian Institutes of Health Research (Priority Announcement: Institute of Musculoskeletal Health and Arthritis). Joanna Sale was, in part, funded by the Ontario Ministry of Health and Long Term Care, Osteoporosis Strategy. Views expressed are those of the researchers and not the Ministry.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    J. E. M. Sale, D. Beaton & L. Frankel

  2. Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada

    J. E. M. Sale, G. Hawker & D. Beaton

  3. Mobility Program, St. Michael’s Hospital, Toronto, ON, Canada

    E. Bogoch

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    E. Bogoch

  5. Department of Medicine, University of Toronto, Toronto, ON, Canada

    G. Hawker

  6. Osteoporosis Research Program, Women’s College Hospital, Toronto, ON, Canada

    G. Hawker

  7. Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

    M. Gignac

  8. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    M. Gignac

  9. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    S. Jaglal

Authors
  1. J. E. M. Sale
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  2. E. Bogoch
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  3. G. Hawker
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  4. M. Gignac
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  6. S. Jaglal
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  7. L. Frankel
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Correspondence to J. E. M. Sale.

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Sale, J.E.M., Bogoch, E., Hawker, G. et al. Patient perceptions of provider barriers to post-fracture secondary prevention. Osteoporos Int 25, 2581–2589 (2014). https://doi.org/10.1007/s00198-014-2804-4

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  • DOI: https://doi.org/10.1007/s00198-014-2804-4

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