title: Patient perceptions of provider barriers to post-fracture secondary prevention.
abstract: 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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, salej@smh.ca.
authors.forename: J E M
authors.initials: JE
authors.lastname: Sale
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.forename: G
authors.initials: G
authors.lastname: Hawker
authors.forename: M
authors.initials: M
authors.lastname: Gignac
authors.forename: D
authors.initials: D
authors.lastname: Beaton
authors.forename: S
authors.initials: S
authors.lastname: Jaglal
authors.forename: L
authors.initials: L
authors.lastname: Frankel
mesh_terms: D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009864:Ontario; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D011446:Prospective Studies; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention / Q000458:organization & administration*
chemical_list: D050071:Bone Density Conservation Agents
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