title: Secondary prevention of fractures after hip fracture: a qualitative study of effective service delivery.
abstract: There is variation in how services to prevent secondary fractures after hip fracture are delivered and no consensus on best models of care. This study identifies healthcare professionals' views on effective care for the prevention of these fractures. It is hoped this will provide information on how to develop services.
  
  
  BACKGROUND
  Hip fracture patients are at high risk of subsequent osteoporotic fractures. Whilst fracture prevention services are recommended, there is variation in delivery and no consensus on best models of care. This study aims to identify healthcare professionals' views on effective care for prevention of secondary fracture after hip fracture.
  
  
  METHODS
  Forty-three semi-structured interviews were undertaken with healthcare professionals involved in delivering fracture prevention across 11 hospitals in one English region. Interviews explored views on four components of care: (1) case finding, (2) osteoporosis assessment, (3) treatment initiation, and (4) monitoring and coordination. Interviews were audio-recorded, transcribed, anonymised and coded using NVivo software.
  
  
  RESULTS
  Case finding: a number of approaches were discussed. Multiple methods ensured there was a 'backstop' if patients were overlooked. Osteoporosis assessment: there was no consensus on who should conduct this. The location of the dual energy X-ray absorptiometry (DXA) scanner influenced the likelihood of patients receiving a scan. Treatment initiation: it was felt this was best done in inpatients rather request initiation in the post-discharge/outpatients period. Monitoring (adherence): adherence was a major concern, and participants felt more monitoring could be conducted by secondary care. Coordination of care: participants advocated using dedicated coordinators and formal and informal methods of communication. A gap between primary and secondary care was identified and strategies suggested for addressing this.
  
  
  CONCLUSIONS
  A number of ways of organising effective fracture prevention services after hip fracture were identified. It is hoped that this will help professionals identify gaps in care and provide information on how to develop services.
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK. sarah.drew@ndorms.ox.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Drew
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.|MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors.forename: A
authors.initials: A
authors.lastname: Judge
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.|MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.|MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors.forename: M K
authors.initials: MK
authors.lastname: Javaid
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Farmer
authors.affiliation: School of Clinical Sciences, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gooberman-Hill
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D017146:Models, Organizational; D010024:Osteoporosis / Q000175:diagnosis; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D036301:Qualitative Research; D012008:Recurrence; D055502:Secondary Prevention / Q000458:organization & administration*
chemical_list: D050071:Bone Density Conservation Agents
keywords: Epidemiology; Fracture; Fragility; Hip; Osteoporosis; Qualitative