GP perceptions on improving a secondary care–based Fracture Liaison Service (FLS)

Manning, Fay; Gould, Kathleen Ahern; Dale, Nicky; Dowson, Claire A.; Paskins, Zoë

doi:10.1007/s00198-020-05648-x

Cited by 5 publications

(5 citation statements)

References 3 publications

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“…We found that more than a quarter of responding UK FLSs did not discuss osteoporosis medicines with patients. This is important because findings from our iFraP qualitative study indicated barriers to GPs discussing osteoporosis medicines with patients: some GPs did not feel confident, describing FLS as ‘best placed’ to have discussions about medicines, whilst other GPs reflected on the lack of financial incentive as an obstacle, in accordance with other research [ 10 , 11 ]. Furthermore, patients and GPs may be unclear as to whether an additional appointment is needed after engagement with the FLS, with services split as to whether they recommended this or not.…”

Section: Discussionsupporting

confidence: 84%

“…Furthermore, patients and GPs may be unclear as to whether an additional appointment is needed after engagement with the FLS, with services split as to whether they recommended this or not. A previous UK GP survey also identified that GPs were not clear on whether or not further drug counselling was needed after FLS [ 11 ]. Taken together, these findings suggest some patients may get duplicate drug counselling, whilst others get none, and this is likely to contribute to the problem of poor adherence.…”

Section: Discussionmentioning

confidence: 99%

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Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey

Bullock,

Abdelmagid,

Fleming

et al. 2023

Arch Osteoporos

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Summary We conducted a survey of FLSs’ consultation conduct and content which identified marked variation in whether FLS HCPs discussed osteoporosis medicine with patients. A review of service pro formas showed more content related to ‘investigating’ and ‘intervening’ than to ‘informing’. We propose an expanded FLS typology and model FLS pro forma. Purpose To investigate the nature of direct patient contact in fracture liaison service (FLS) delivery, examine the use and content of pro formas to guide information eliciting and sharing in FLS consultations, and determine service changes which were implemented as a result of the COVID-19 pandemic. Methods An electronic survey of UK FLS healthcare practitioners (HCPs) was distributed through clinical networks, social media, and other professional networks. Participants were asked to upload service pro formas used to guide consultation content. Documentary analysis findings were mapped to UK FLS clinical standards. Results Forty-seven HCPs responded, providing data on 39 UK FLSs, over half of all 74 FLSs reporting to FLS-database. Results showed variation in which HCP made clinical decisions, whether medicines were discussed with patients or not, and in prescribing practice. Services were variably affected by COVID, with most reporting a move to more remote consulting. The documentary analysis of eight service pro formas showed that these contained more content related to ‘investigating’ and ‘intervening’, with fewer pro formas prompting the clinician to offer information and support (e.g., about coping with pain). Based on our findings we propose an expanded FLS typology and have developed a model FLS pro forma. Conclusion There is marked variation in the delivery of services and content of consultations in UK FLSs including discussion about osteoporosis medications. Clinical standards for FLSs should clarify the roles of primary and secondary HCPs and the importance of holistic approaches to patient care.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey

Bullock,

Abdelmagid,

Fleming

et al. 2023

Arch Osteoporos

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“…This study is unique in that it provides a system-wide perspective on the barriers and supports affecting the key stakeholders (patients, FLS clinicians, and GPs) across the healthcare continuum. Previous qualitative studies exploring perceptions of post-fracture FLS care have largely focussed on the experiences of one or two stakeholder groups within a service: hospital clinicians [29], patients [30], or GPs [31] alone, or patients and GPs [32]. These and other studies [33] have highlighted a lack of communication, coordination, and cooperation between acute and PC [29,31,34].…”

Section: Discussionmentioning

confidence: 99%

“…Previous qualitative studies exploring perceptions of post-fracture FLS care have largely focussed on the experiences of one or two stakeholder groups within a service: hospital clinicians [29], patients [30], or GPs [31] alone, or patients and GPs [32]. These and other studies [33] have highlighted a lack of communication, coordination, and cooperation between acute and PC [29,31,34]. Likewise, a longitudinal study of 50 patients, 26 surgeons, and 8 GPs exploring PC follow-up after orthopaedic fracture clinic attendance found similar failures of interprofessional communication adversely affected GP follow-up care [32].…”

Section: Discussionmentioning

confidence: 99%

Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study

2023

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This qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide. Introduction Fracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare. Methods Qualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices. Results Seven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP-patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps. Conclusion Key challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide.

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“…Our earlier research, and that of other authors [ 41 ], identified healthcare practitioner role ambiguity as a leading factor affecting the quality of the FLS to primary care transition for patients with osteoporosis. Our current study sought to address this by seeking consensus on the roles of FLS and GPs in both a type A and type B models of care.…”

Section: Discussionmentioning

confidence: 73%

Establishing consensus recommendations for long-term osteoporosis care for patients who have attended an Australian fracture liaison service: a Delphi study

Bennett,

Center,

Perry

2024

Osteoporos Int

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Summary Coordinating healthcare activities between fracture liaison services (FLS) and primary care is challenging. Using a Delphi technique, we developed 34 consensus statements to support improved care coordination across this healthcare transition. Purpose Evidence supporting an optimal coordination strategy between fracture liaison services (FLS) and primary care is lacking. This study aimed to develop consensus statements to support consistency and benchmarking of clinical practice to improve coordination of care for patients transitioning from FLS to primary care following an osteoporotic fracture. Methods A Delphi technique was used to develop consensus among a panel of experts, including FLS clinicians (medical and non-medical), general practitioners (GPs), and consumers. Results Results of a preparatory questionnaire ( n = 33) informed the development of 34 statements for review by expert panellists over two Delphi rounds ( n = 25 and n = 19, respectively). The majority of participants were from New South Wales (82%), employed as FLS clinicians (78.8%) and working in metropolitan centres (60.6%). Consensus was achieved for 24/34 statements in round one and 8/10 statements in round two. All statements concerning patient education, communication, and the GP-patient relationship achieved consensus. Expert opinions diverged in some areas of clinician roles and responsibilities and long-term monitoring and management recommendations. Conclusion We found clear consensus among experts in many key areas of FLS integration with primary care. While experts agreed that primary care is the most appropriate setting for long-term osteoporosis care, overall confidence in primary care systems to achieve this was low. The role of (and responsibility for) adherence monitoring in a resource-limited setting remains to be defined.

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GP perceptions on improving a secondary care–based Fracture Liaison Service (FLS)

Cited by 5 publications

References 3 publications

Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey

Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey

Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study

Establishing consensus recommendations for long-term osteoporosis care for patients who have attended an Australian fracture liaison service: a Delphi study

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