Primary care physicians' views on osteoporosis management: a qualitative study.

Osteoporosis is an under-diagnosed condition; only around 14% of patients in Sweden receive bone-specific treatment after a fragility fracture. This qualitative interview study found that primary care physicians perceive osteoporosis as a silent disease that is overshadowed by other conditions and is complicated to manage. PURPOSE: To explore primary care physicians' views on managing osteoporosis. METHODS: A total of 17 primary care physicians in Stockholm participated in four focus group interviews. Interview transcripts were analysed with thematic analysis. RESULTS: One main theme was found: Osteoporosis-a silent disease overshadowed by other conditions. The main theme contained five sub-themes. Physicians perceived osteoporosis as a low-priority issue. They described uncertainty about managing it and insufficient awareness of the condition in primary healthcare (PHC). Physicians had differing opinions about who is responsible for managing osteoporosis. They reported that the health care system regulated their work such that they gave low priority to the condition. They were uncertain about the value of the Fracture Risk Assessment Tool (FRAX). The physicians thought that financial incentives, education, and increased collaboration with other relevant health care professionals and with patients were needed to increase the priority of osteoporosis in PHC. CONCLUSION: Physicians perceived osteoporosis as a silent disease that is complicated to manage. They gave low priority to osteoporosis and thought their patients shared this view. The physicians saw other issues and medical conditions as more important than osteoporosis. They wanted better collaboration at their PHC centres and with hospitals. They also wanted district nurses to be more involved in managing osteoporosis and especially in assessing fracture risk.

District nurses' perceptions of osteoporosis management: a qualitative study.

UNLABELLED: Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. INTRODUCTION: Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. METHODS: Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. RESULTS: The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. CONCLUSIONS: Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.