Osteoporosis care through an Integrated, People-Centred Health Services framework lens: a hybrid qualitative analysis of international patient experiences

Abstract

ObjectivesGlobally, patients with osteoporosis have unmet needs in terms of care accessibility, patient-centredness and care comprehensiveness. The WHO developed the Integrated, People-Centred Health Services (IPCHS) framework to reorient and integrate healthcare systems using 5 interdependent strategies and 20 substrategies. Patients’ perspectives with regard to these strategies are poorly understood. We sought to relate patient-experienced gaps in osteoporosis care to the IPCHS strategies and identify key strategies to guide osteoporosis care reforms.Design, setting and participantsQualitative online study of the experiences of international patients with osteoporosis.ProcedureTwo researchers conducted semi-structured interviews in English, Dutch, Spanish and French that were recorded and transcribed verbatim. Patients were categorised according to their countries’ healthcare systems (universal, public/private and private) and fracture status. A hybrid (sequential theory-driven and data-driven) analysis was performed, with the IPCHS framework used for the theory-driven analysis.ResultsThirty-five patients (33 women) from 14 countries participated. Twenty-two patients had universal healthcare and 18 had experienced fragility fractures. Prioritised substrategies overlapped among healthcare systems, with reported shortcomings related primarily to ‘empowering and engaging individuals and families’ and ‘coordinating care’ (at varying levels). Patients with all healthcare types prioritised ‘reorienting care’, with different substrategies prioritised. Patients with private healthcare called for ‘improving funding and reforming payment systems’. Substrategy prioritisation did not differ between those receiving primary and secondary fracture prevention.ConclusionPatients’ experiences with osteoporosis care are universal. Given the current care gaps and associated patient burdens, policymakers should make osteoporosis a(n) (inter)national health priority. Integrated osteoporosis care reforms should focus on patient-reported experiences with and be guided by priorities in IPCHS strategies, taking into account the healthcare system context.

Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study

“…The first level of competition arises from tension between PCPs’ primary objective to address the immediate concerns presented by patients and allocating time to prevention. In our study, PCPs contented little patient interest for prevention, a viewpoint consistent with findings from Mirand et al [ 14 ], although diverging from our own research involving patients [ 15 ]. Furthermore, our findings underscore the challenge faced by PCPs to execute their mandate: in the current context, there is insufficient time to address all preventive services while simultaneously attending to acute care needs and overseeing the monitoring and follow-up of chronic diseases.…”

“…However, research on the factors driving the patient’s consultation agenda may be needed, as solely addressing awareness may not suffice; iii. impeding as many barriers as possible to fracture prevention, such as offering DXA and osteoporosis treatment at an absolute minimum of out-of-pocket costs [ 15 , 25 ]. Furthermore, it is worth exploring the utility of bone turnover markers as a diagnostic tool for osteoporosis.…”