title: Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada.
abstract: BACKGROUND
  Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers.
  
  
  METHODS
  We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans.
  
  
  RESULTS
  LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences.
  
  
  CONCLUSIONS
  This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.
authors.affiliation: Department of Medicine, Division of Geriatrics, McMaster University, 88 Maplewood Ave, Hamilton, ON, L8M 1 W9, Canada. shalamri1@kau.edu.sa.|Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. shalamri1@kau.edu.sa.|Geriatrics Residency Program, St. Joseph's Hospital, McMaster University, 50 Charlton Ave. E., Hamilton, ON, L8N 4A6, Canada. shalamri1@kau.edu.sa.
authors.forename: Sultan H
authors.initials: SH
authors.lastname: Alamri
authors.affiliation: Department of Medicine, Division of Geriatrics, McMaster University, 88 Maplewood Ave, Hamilton, ON, L8M 1 W9, Canada. kennedyc@HHSC.CA.|Juravinski Research Centre, Hamilton Health Sciences - St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. kennedyc@HHSC.CA.|Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S4K1, Canada. kennedyc@HHSC.CA.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Kennedy
authors.affiliation: Department of Medicine, Division of Geriatrics, McMaster University, 88 Maplewood Ave, Hamilton, ON, L8M 1 W9, Canada. marrs@mcmaster.ca.|Juravinski Research Centre, Hamilton Health Sciences - St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. marrs@mcmaster.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Marr
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S4K1, Canada. lohfeld@mcmaster.ca.
authors.forename: Lynne
authors.initials: L
authors.lastname: Lohfeld
authors.affiliation: Juravinski Research Centre, Hamilton Health Sciences - St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. skidmorec@hhsc.ca.
authors.forename: Carly J
authors.initials: CJ
authors.lastname: Skidmore
authors.affiliation: Department of Medicine, Division of Geriatrics, McMaster University, 88 Maplewood Ave, Hamilton, ON, L8M 1 W9, Canada. papaioannou@HHSC.CA.|Juravinski Research Centre, Hamilton Health Sciences - St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, ON, L8M 1 W9, Canada. papaioannou@HHSC.CA.|Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S4K1, Canada. papaioannou@HHSC.CA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003144:Communication Barriers; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000523:psychology / Q000592:standards; D008297:Male; D009864:Ontario; D010024:Osteoporosis / Q000150:complications / Q000628:therapy; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents