Osteoporosis International

, Volume 19, Issue 11, pp 1527–1540 | Cite as

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

  • A. C. Feldstein
  • J. Schneider
  • D. H. Smith
  • W. M. Vollmer
  • M. Rix
  • H. Glauber
  • D. L. Boardman
  • M. Herson
Original Article

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.

Keywords

Barriers Bone mineral density Facilitators Medication Osteoporosis 

References

  1. 1.
    National Osteoporosis Foundation (2000) Physicians guide to prevention and treatment of osteoporosisGoogle Scholar
  2. 2.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMedGoogle Scholar
  3. 3.
    Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778CrossRefPubMedGoogle Scholar
  4. 4.
    Feldstein AC, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen C, Aickin M, Swain MC (2006) Electronic medical record reminder improves osteoporosis management after a fracture: A randomized, controlled trial. J Am Geriatr Soc 54:450–457CrossRefPubMedGoogle Scholar
  5. 5.
    Gardner MJ, Brophy RH, Demetrakopoulos D, Koob J, Hong R, Rana A, Lin JT, Lane JM (2005) Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. J Bone Joint Surg Am 87:3–7CrossRefPubMedGoogle Scholar
  6. 6.
    Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373CrossRefPubMedGoogle Scholar
  7. 7.
    Bliuc D, Eisman JA, Center JR (2006) A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int 17:1309–1317CrossRefPubMedGoogle Scholar
  8. 8.
    Feldstein AC, Vollmer WM, Smith DH, Petrik A, Schneider J, Glauber H, Herson M (2007) An outreach program improved osteoporosis management after a fracture. J Am Geriatr Soc 55:1464–1469 [Epub 2007 Jul 30]CrossRefPubMedGoogle Scholar
  9. 9.
    Ali NS, Twibell KR (1994) Barriers to osteoporosis prevention in perimenopausal and elderly women. Geriatr Nurs 15:201–205CrossRefPubMedGoogle Scholar
  10. 10.
    Burgener M, Arnold M, Katz JN, Polinski JM, Cabral D, Avorn J, Solomon DH (2005) Older adults’ knowledge and beliefs about osteoporosis: results of semistructured interviews used for the development of educational materials. J Rheumatol 32:673–677PubMedGoogle Scholar
  11. 11.
    Jaglal SB, Cameron C, Hawker GA, Carroll J, Jaakkimainen L, Cadarette SM, Bogoch ER, Kreder H, Davis D (2006) Development of an integrated-care delivery model for post-fracture care in Ontario, Canada. Osteoporos Int 17:1337–1345CrossRefPubMedGoogle Scholar
  12. 12.
    Freeborn DK, Pope C (1994) Promise and performance in managed care: the prepaid group practice modelGoogle Scholar
  13. 13.
    Feldstein AC, Glasgow RE (2008) A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Joint Commission Journal on Quality and Patient Safety, March, In PressGoogle Scholar
  14. 14.
    Feldstein AC, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: A gap in evidence-based practice guideline. Arch Intern Med 163:2165–2172CrossRefPubMedGoogle Scholar
  15. 15.
    Erlandson DA, Harris EL, Skipper BL, Allen SD (1993) Doing naturalistic inquiry: a guide to methodsGoogle Scholar
  16. 16.
    Marshall C, Rossman GB (1995) Designing Qualitative Research. 2nd EdnGoogle Scholar
  17. 17.
    Lincoln YS, Guba EG (1985) Naturalistic InquiryGoogle Scholar
  18. 18.
    Lofland l, Lofland J (1995) Analyzing Social Settings: A guide to qualitative observation and analysis. 3rd EdnGoogle Scholar
  19. 19.
    Wolcott HF (1994) Transforming Qualitative Data: Description, Analysis, and InterpretationGoogle Scholar
  20. 20.
    Strauss AL, Corbin JM (1990) Basics of qualitative research: Grounded theory procedures and techniquesGoogle Scholar
  21. 21.
    Ettinger B, Pressman AR, Schein J, Chan J, Silver P, Connolly N (1998) Alendronate use among 812 women: Prevalence of gastrointestinal complaints, non-compliance with patient instructions, and discontinuation. J Manag Care Pharm 4:488–492Google Scholar
  22. 22.
    Jaglal SB, McIsaac WJ, Hawker G, Carroll J, Jaakkimainen L, Cadarette SM, Cameron C, Davis D (2003) Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporos Int 14:672–676CrossRefPubMedGoogle Scholar
  23. 23.
    Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, Cameron C, Davis D (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468 462–68PubMedPubMedCentralGoogle Scholar
  24. 24.
    Blalock SJ, Currey SS, DeVellis RF, DeVellis BM, Giorgino KB, Anderson JJ, Dooley MA, Gold DT (2000) Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behavior. Am J Health Promot 14:161–169CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • A. C. Feldstein
    • 1
    • 2
    • 3
  • J. Schneider
    • 2
  • D. H. Smith
    • 2
  • W. M. Vollmer
    • 2
  • M. Rix
    • 2
  • H. Glauber
    • 1
  • D. L. Boardman
    • 1
  • M. Herson
    • 1
  1. 1.Northwest PermanentePortlandUSA
  2. 2.Center for Health Research, Kaiser Permanente NorthwestPortlandUSA
  3. 3.Center for Health ResearchPortlandUSA

Personalised recommendations