Poster Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Integrating Post-Fracture Care into the Primary Care Setting (interFRACT): Phase 1 Results of a Mixed-Methods Co-Design Study (#239)

Jason Talevski 1 2 3 , Alison Beauchamp 4 , Stefanie Bird 2 5 , Jakub Mesinovic 3 6 , Paul Jansons 3 6 , Jackson Fyfe 3 , David Scott 3 6 , Robin Daly 3
  1. Northern Health, Epping, VIC, Australia
  2. Australian Institute for Musculoskeletal Science (AIMSS), St Albans, VIC, Australia
  3. Deakin University, Burwood, VIC, Australia
  4. Monash University, Waragul, VIC, Australia
  5. The University of Melbourne, Melbourne, VIC, Australia
  6. Monash University, Clayton, VIC, Australia

Objectives: To develop the interFRACT care pathway to enhance diagnosis/treatment of osteoporosis and improve initiation of fracture prevention strategies for older adults in the primary care (PC) setting.

Methods: This mixed-methods study uses an established co-design approach (Figure 1). Phase 1 involved developing a Stakeholder Advisory Committee (SAC) to guide study procedures and outcomes; interviews with 15 GPs and 20 consumers (older adults >50 years with osteoporosis and/or fragility fracture) to explore beliefs and attitudes toward osteoporosis and fractures; and a scoping review to investigate current approaches, needs and barriers to osteoporosis and post-fracture treatment within PC.

Results: The SAC was developed and includes 2 GPs; 1 geriatrician; 1 fracture liaison nurse; 1 exercise physiologist; 2 representatives from the Fragility Fracture Network and Musculoskeletal Australia; and 5 consumers. Analyses of interviews showed that most GPs gave low priority to osteoporosis and saw other medical conditions as more important; consumers also shared this view. Most GPs felt confident in managing osteoporosis, however consumers perceived their care as inadequate and felt GPs lacked knowledge in non-pharmacological treatments (e.g. exercise). Noted as the “acute-PC divide”, GPs desired better collaboration with hospitals and commonly spoke about delayed or poor-quality communication. Both groups made suggestions of how osteoporosis and fracture management could be improved in PC. Ninety studies were included in the scoping review, which identified several key themes: Lack of GP knowledge; Low osteoporosis diagnosis and treatment Rates; Interventions to Improve Osteoporosis Diagnosis/Treatment; and Barriers to Osteoporosis Management.

Conclusions: These findings have allowed us to gain an understanding of consumer and GP experiences and needs within PC. Phase 2 will include a series of co-design workshops with the SAC to develop the interFRACT care pathway using phase 1 results, and a feasibility study with GPs to determine the usability/acceptability of the care pathway.

 

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