Pharmacist-led osteoporosis review: perceptions of current practice, care gaps, and implementation challenges.

Abstract

Adherence to oral bisphosphonates for osteoporosis is poor; the challenges and complexity of follow-up reviews in general practice are implicated as a contributory cause. Clinical pharmacists in general practice are an expanding professional group within the UK NHS workforce and could provide person-centred medicines optimisation interventions. To explore clinician and patient perceptions towards a pharmacist-led osteoporosis review, including identifying current practice, care gaps, and implementation barriers and facilitators. Qualitative interview study with patients, clinical pharmacists, GPs, osteoporosis specialists, and service commissioners. Semi-structured interviews were transcribed verbatim and analysed thematically, informed by a normalisation process theory approach. In total, 32 participants were interviewed in 22 one-to-one interviews and four small group interviews. Three themes relevant to the design and implementation of a pharmacist-led osteoporosis follow-up review were identified: dissonant views among patients and healthcare professionals about current provision and needs; pharmacists' suitability for, and role in, osteoporosis care and training needs; and contextual issues affecting implementation of a new pharmacist-led osteoporosis review. Our study found that current practice with respect to following-up patients initiated on oral bisphosphonate treatment in primary care is variable. Although pharmacists were highlighted as well-placed to conduct osteoporosis reviews, varying views about the need for this were highlighted along with a number of contextual barriers, including lack of financial and policy drivers in primary care, workload challenges, varying pharmacist skills and autonomy, and lack of coordination across the health system.