Advertisement

Osteoporosis International

, Volume 24, Issue 6, pp 1803–1815 | Cite as

The role of community pharmacists in the prevention and management of osteoporosis and the risk of falls: results of a cross-sectional study and qualitative interviews

  • M.-C. Laliberté
  • S. Perreault
  • N. Damestoy
  • L. LalondeEmail author
Original Article

Abstract

Summary

In a mailed survey and qualitative interviews, it was observed that community pharmacists and public health authorities believe that pharmacists should play a significant role in the prevention and management of osteoporosis and the risk of falls. However, pharmacists acknowledge a wide gap between their ideal and actual levels of involvement.

Introduction

The aim of this study was to explore perceptions of community pharmacists and public health authorities regarding the role of pharmacists in providing services in relation to osteoporosis and risk of falls and the barriers to providing them.

Methods

Using a modified five-step version of Dillman’s tailored design method, a questionnaire was mailed to a random sample of 1,250 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. A similar questionnaire was sent to public health officers in these regions. Additionally, telephone interviews were conducted with regional and ministry level public health officers.

Results

Of the 1,250 pharmacists contacted, 28 were ineligible. In all, 571 of 1,222 (46.7 %) eligible community pharmacists and all the public health officers returned the questionnaire. Six public health officers (five regional and one at ministry level) were interviewed. Most pharmacists believed they should be involved in screening for osteoporosis (46.6 %) and risk of falls (50.3 %); however, fewer reported actually being involved in such services (17.4 % and 19.2 %, respectively). In their view, the main barriers to providing these services in current practice were lack of time (78.8 %), lack of clinical tools (65.4 %), and lack of coordination with other healthcare professionals (54.5 %). Public health authorities also thought community pharmacists should play a significant role in providing osteoporosis and fall risk services. However, few community pharmacist-mediated activities are in place in the participating regions.

Conclusions

Although community pharmacists and public health authorities believe pharmacists should play a significant role with regard to osteoporosis and the risk of falls, they acknowledge a wide gap between the ideal and actual levels of pharmacist involvement.

Keywords

Community pharmacy Cross-sectional study Osteoporosis Qualitative study Risk of falls 

Notes

Acknowledgments

MCL is supported by a doctoral research award from the Canadian Institutes of Health Research (CIHR) in partnership with Osteoporosis Canada. LL and SP are research scholars who receive financial support from the Fonds de Recherche du Québec—Santé. We thank all participants who responded to the questionnaire and took part in the interviews.

Financial disclosure

Réseau québécois de recherche sur l’usage des médicaments (RQRUM) and Agence de la santé et des services sociaux de Laval

Conflicts of interest

None

References

  1. 1.
    O’Loughlin J, Masson P, Dery V, Fagnan D (1999) The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease. Prev Med 28:324–331PubMedCrossRefGoogle Scholar
  2. 2.
    Paluck EC, Stratton TP, Eni GO (1994) Community pharmacists’ participation in health education and disease prevention activities. Can J Public Health 85:389–392PubMedGoogle Scholar
  3. 3.
    Chandra A, Malcolm N 2nd, Fetters M (2003) Practicing health promotion through pharmacy counseling activities. Health Promot Pract 4:64–71PubMedCrossRefGoogle Scholar
  4. 4.
    Anderson C, Blenkinsopp A, Armstrong M (2009) The contribution of community pharmacy to improving the public’s health: summary report of the litterature review 1990–2007. www.pharmacyhealthlink.org.uk. Accessed 11 August 2011
  5. 5.
    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 15:767–778PubMedCrossRefGoogle Scholar
  6. 6.
    Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11PubMedCrossRefGoogle Scholar
  7. 7.
    Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305PubMedCrossRefGoogle Scholar
  8. 8.
    Ashe M, Khan K, Guy P, Kruse K, Hughes K, O’Brien P et al (2004) Wristwatch-distal radial fracture as a marker for osteoporosis investigation: a controlled trial of patient education and a physician alerting system. J Hand Ther 17:324–328PubMedCrossRefGoogle Scholar
  9. 9.
    Cranney A, Lam M, Ruhland L, Brison R, Godwin M, Harrison MM et al (2008) A multifaceted intervention to improve treatment of osteoporosis in postmenopausal women with wrist fractures: a cluster randomized trial. Osteoporos Int 19:1733–1740PubMedCrossRefGoogle Scholar
  10. 10.
    Feldstein A, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen C et al (2006) Electronic medical record reminder improves osteoporosis management after a fracture: a randomized, controlled trial. J Am Geriatr Soc 54:450–457PubMedCrossRefGoogle Scholar
  11. 11.
    Lafata JE, Kolk D, Peterson EL, McCarthy BD, Weiss TW, Chen YT et al (2007) Improving osteoporosis screening: results from a randomized cluster trial. J Gen Intern Med 22:346–351PubMedCrossRefGoogle Scholar
  12. 12.
    Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMedCrossRefGoogle Scholar
  13. 13.
    Majumdar SR, Beaupre LA, Harley CH, Hanley DA, Lier DA, Juby AG et al (2007) Use of a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial. Arch Intern Med 167:2110–2115PubMedCrossRefGoogle Scholar
  14. 14.
    Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C et al (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367PubMedCrossRefGoogle Scholar
  15. 15.
    Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA et al (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815PubMedCrossRefGoogle Scholar
  16. 16.
    Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT (2010) Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial. Osteoporos Int 21:391–398PubMedCrossRefGoogle Scholar
  17. 17.
    Laliberte MC, Perreault S, Jouini G, Shea BJ, Lalonde L (2011) Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporos Int 22:2743–2768PubMedCrossRefGoogle Scholar
  18. 18.
    Teng GG, Warriner A, Curtis JR, Saag KG (2008) Improving quality of care in osteoporosis: opportunities and challenges. Curr Rheumatol Rep 10:123–130PubMedCrossRefGoogle Scholar
  19. 19.
    Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Phys 49:462–468Google Scholar
  20. 20.
    Naunton M, Peterson GM, Jones G (2006) Pharmacist-provided quantitative heel ultrasound screening for rural women at risk of osteoporosis. Ann Pharmacother 40:38–44PubMedCrossRefGoogle Scholar
  21. 21.
    Chaiyakunapruk N, Laowakul A, Karnchanarat S, Pikulthong N, Ongphiphadhanakul B (2006) Community pharmacy-based implementation and evaluation of an osteoporosis self-assessment tool for Asians. J Am Pharm Assoc 46:391–396Google Scholar
  22. 22.
    Law AV, Shapiro K (2005) Impact of a community pharmacist-directed clinic in improving screening and awareness of osteoporosis. J Eval Clin Pract 11:247–255PubMedCrossRefGoogle Scholar
  23. 23.
    MacLaughlin EJ, MacLaughlin AA, Snella KA, Winston TS, Fike DS, Raehl CR (2005) Osteoporosis screening and education in community pharmacies using a team approach. Pharmacotherapy 25:379–386PubMedCrossRefGoogle Scholar
  24. 24.
    Summers KM, Brock TP (2005) Impact of pharmacist-led community bone mineral density screenings. Ann Pharmacother 39:243–248PubMedCrossRefGoogle Scholar
  25. 25.
    Cerulli J, Zeolla MM (2004) Impact and feasibility of a community pharmacy bone mineral density screening and education program. J Am Pharm Assoc 44:161–167CrossRefGoogle Scholar
  26. 26.
    Goode JV, Swiger K, Bluml BM (2004) Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from Project ImPACT: Osteoporosis. J Am Pharm Assoc 44:152–160CrossRefGoogle Scholar
  27. 27.
    Elliott ME, Meek PD, Kanous NL, Schill GR, Weinswig PA, Bohlman JP et al (2002) Osteoporosis screening by community pharmacists: use of National Osteoporosis Foundation resources. J Am Pharm Assoc 42:101–110CrossRefGoogle Scholar
  28. 28.
    Lata PF, Binkley NC, Elliott ME (2002) Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers. Menopause 9:449–455PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson JF, Koenigsfeld C, Hughell L, Parsa RA, Bravard S (2008) Bone health screening, education, and referral project in northwest Iowa: creating a model for community pharmacies. J Am Pharm Assoc 48:379–387CrossRefGoogle Scholar
  30. 30.
    McDonough RP, Doucette WR, Kumbera P, Klepser DG (2005) An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis. Value Health 8:24–31PubMedCrossRefGoogle Scholar
  31. 31.
    Direction générale de la santé publique du ministère de la Santé et des Services sociaux (2003) Programme national de santé publique 2003–2012. http://www.rrsss12.gouv.qc.ca/documents/Programme_nationale_sante_pub.pdf. Accessed 11 August 2011
  32. 32.
    Dillman DA (2000) Mail and Internet surveys: the tailored design method. John Wiley and Sons Inc., New YorkGoogle Scholar
  33. 33.
    Krska J, Morecroft CW (2010) Views of the general public on the role of pharmacy in public health. J Pharm Health Serv Res 1:33–38Google Scholar
  34. 34.
    Britten N (1995) Qualitative interviews in medical research. BMJ 311:251–253PubMedCrossRefGoogle Scholar
  35. 35.
    Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG (eds) Analyzing qualitative data, 1st edn. Routledge, New York, pp 173–194CrossRefGoogle Scholar
  36. 36.
    Jorgenson D, Lamb D, MacKinnon NJ (2011) Practice change challenges and priorities: a national survey of practising pharmacists. Can Pharm J 144:125–131CrossRefGoogle Scholar
  37. 37.
    Eades CE, Ferguson JS, O’Carroll RE (2011) Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Publ Health 11:582CrossRefGoogle Scholar
  38. 38.
    Laliberte MC, Perreault S, Damestoy N, Lalonde L (2012) Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada. BMC Publ Health 12:192CrossRefGoogle Scholar
  39. 39.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG et al. (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev Issue 2:CD007146Google Scholar
  40. 40.
    Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness. JAMA 288:1775–1779PubMedCrossRefGoogle Scholar
  41. 41.
    Wagner EH, Austin BT, Von Korff M (1996) Organizing care for patients with chronic illness. Milbank Q 74:511–544PubMedCrossRefGoogle Scholar
  42. 42.
    Phaneuf M (2008) Bill 90 and the therapeutic nursing plan. http://www.infiressources.ca/fer/Depotdocument_anglais/Bill_90_and_the_therapeutic_nursing_plan.pdf. Accessed 30 August 2011
  43. 43.
    Jaglal SB, Donescu OS, Bansod V, Laprade J, Thorpe K, Hawker G et al (2012) Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial. Osteoporos Int 23:87–95PubMedCrossRefGoogle Scholar
  44. 44.
    Adler RA, Bates DW, Dell RM, LeBoff MS, Majumdar SR, Saag KG et al (2011) Systems-based approaches to osteoporosis and fracture care: policy and research recommendations from the workgroups. Osteoporos Int 22(Suppl 3):495–500PubMedCrossRefGoogle Scholar
  45. 45.
    Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • M.-C. Laliberté
    • 1
    • 2
  • S. Perreault
    • 1
    • 3
  • N. Damestoy
    • 4
    • 5
    • 6
  • L. Lalonde
    • 1
    • 2
    • 7
    • 8
    Email author
  1. 1.Faculty of PharmacyUniversité de MontréalQuebecCanada
  2. 2.Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de LavalQuebecCanada
  3. 3.Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of PharmacyUniversité de MontréalQuebecCanada
  4. 4.Direction Prévention-Promotion, Centre de santé et de services sociaux de LavalQuebecCanada
  5. 5.Direction de santé publiqueAgence de la santé et des services sociaux de LavalQuebecCanada
  6. 6.Faculty of MedicineUniversité de MontréalQuebecCanada
  7. 7.Centre de rechercheCentre hospitalier de l’Université de MontréalMontrealCanada
  8. 8.Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of PharmacyUniversité de MontréalQuebecCanada

Personalised recommendations