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


BACKGROUND
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.
Feldstein
A C
AC
Northwest Permanente, Portland, OR, USA. adrianne.c.feldstein@kpchr.org
Schneider
J
J
Smith
D H
DH
Vollmer
W M
WM
Rix
M
M
Glauber
H
H
Boardman
D L
DL
Herson
M
M
D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D017144:Focus Groups; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy*; D011320:Primary Health Care / Q000592:standards; D015397:Program Evaluation; D011787:Quality of Health Care; D014481:United States
D050071:Bone Density Conservation Agents