title: District nurses' perceptions of osteoporosis management: a qualitative study.
abstract: Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention.
  
  
  BACKGROUND
  Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system.
  
  
  METHODS
  Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis.
  
  
  RESULTS
  The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture.
  
  
  CONCLUSIONS
  Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.
authors: Unit of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden, anne.claesson@ki.se.
authors: A
authors: A
authors: Claesson
authors: E
authors: E
authors: Toth-Pal
authors: P
authors: P
authors: Piispanen
authors: H
authors: H
authors: Salminen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D002983:Clinical Competence; D015400:Clinical Nursing Research / Q000379:methods; D003153:Community Health Services / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards; D019468:Disease Management; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D064691:Nurses, Community Health / Q000523:psychology*; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D013548:Sweden
chemical_list: D050071:Bone Density Conservation Agents