Osteoporosis group consultations are as effective as usual care: Results from a non-inferiority randomized trial

Abstract

Background

Group consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.

Objective

To show effectiveness in other musculoskeletal conditions with other professionals.

Hypothesis

Group consultations as effective as one-to-one consultations for treating patients at risk of osteoporotic fracture, defined by 10-year fracture risk.

Design

Randomized controlled non-inferiority trial, with parallel groups randomized by patient

Setting

Three primary care practices, Northumberland, United Kingdom

Patients

A total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10-year fracture risk group.

Interventions

Pharmacist-led clinic appointment either in one of four 90-min group consultations (n = 75) or comparator usual care consultation (n = 83).

Measurements

Primary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.

Results

Ten-year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23-0.92) for group and 0.54 (IQR = 0.15-0.92) for usual care (confirmed as non-inferior).

Limitations

Single pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.

Conclusions

Outcomes for group consultations were non-inferior to those for usual care in osteoporosis. Mean pharmacist contact time per patient was lower for group consultations, so this model was efficient and saved costs. Clinicians from different disciplines with facilitation skills can be trained easily and improve routine service delivery for chronic conditions through group consultations: a promising response to escalating demand for healthcare.