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

Abstract

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.

A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol

“…We hypothesize that the iFraP intervention will improve patient ease in decision-making about osteoporosis medicines (by increasing the extent that the patient was informed and involved in the consultation), facilitate shared decision-making, increase informed medicine initiation and reduce levels of medicine discontinuation. A protocol outlining the studies that underpinned iFraP intervention development is published 20 , and the results of the development studies are also reported elsewhere 17,[21][22][23] .…”

“…Service provision varies across FLSs, with services ranging from operating a 'one-stop shop' model of care, meaning that, if appropriate, patients have a bone density scan (Dual-energy X-ray absorptiometry [DXA]), nurse assessment, drug treatment recommendation, and blood tests as part of one consultation. Other FLS models may not complete all components for all patients (for example, not all patients receive a DXA scan), or may split these components across multiple appointments, supported by different communication modalities (remote, face-to-face, letter) 22 .…”

Exploring practice and perspectives on shared decision-making about osteoporosis medicines in Fracture Liaison Services: the iFraP development qualitative study

“…This finding necessitated a national survey of FLS usual care to quantify the number of services which discuss osteoporosis medicines with patients, in which the iFraP intervention would be relevant. The iFraP national survey of FLS usual care found that more than a quarter of responding UK FLSs did not explain osteoporosis medicines with the patient [48]. This is important given that GPs' report lacking confidence, knowledge, and skills to discuss osteoporosis medicine.…”