Osteoporosis care in primary care settings: a national UK e-survey

Abstract

Summary

An electronic survey of 341 UK primary care staff identified barriers to evidence-based osteoporosis care including low confidence in clinical skills, the complex nature of decision-making, insufficient incentivisation and lack of systematic case finding. Opportunities to enhance osteoporosis care may include enhanced education and wider utilisation of the extended workforce.

Purpose

To investigate the beliefs, confidence and practices of general practice staff in the care of people with, or at increased risk of, osteoporotic fractures and the association between professional role and beliefs and confidence about osteoporosis care.

Methods

An electronic survey was designed and distributed to UK general practice staff, including healthcare professionals (HCPs) and non-healthcare professionals (non-HCPs). Content was informed by UK clinical guidelines, a scoping review and patient and clinical stakeholder input. Descriptive statistics and Fisher’s exact test were utilised for analysis, with free text responses analysed using reflexive thematic analysis.

Results

Three hundred forty-one responses were obtained (309 HCPs, 32 non-HCPs). Most responding HCPs (173, 62.2%) and non-HCPs (17, 70.8%) reported osteoporosis management of moderate priority. The majority of HCPs (228, 73.8%) agreed that they were worried about osteoporosis medicines causing unpleasant side effects. Most respondents (314, 98.7%) reported GPs as involved in osteoporosis care, followed by Pharmacists (241, 75.8%) and Practice Nurses (159, 50.0%). GPs and Pharmacists reported the highest level of agreement with confidence in osteoporosis medicine related skills. Fewer than a third of respondents reported systematic invitation of patients with risk factors (fracture, steroids or falls) for assessment. Free text responses indicated problems with communication between primary and secondary care, challenging decision-making, limited access to resources (e.g. DXA scan, dentistry) and insufficient incentivisation as barriers to delivery of recommended osteoporosis care.

Conclusion

Identified opportunities to improve osteoporosis care include improved education, incentivisation, automated case finding and involvement of the wider primary care workforce, particularly Pharmacists.