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Cho C, Bak G, Sumpton D, Richards B, Sherrington C. Perspectives of healthcare providers on osteoporosis, falls and fracture risk: a systematic review and thematic synthesis of qualitative studies. Arch Osteoporos 2024; 19:90. [PMID: 39313605 PMCID: PMC11420259 DOI: 10.1007/s11657-024-01446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE Osteoporosis and falls are major risk factors for osteoporotic fractures, with significant detriment to patients' quality of life. We aimed to describe healthcare provider (HCP) perspectives and experiences in the diagnosis, management and prevention of osteoporosis, falls and fractures obtained through primary qualitative research. METHODS Thematic synthesis was performed on articles identified through a search of electronic databases (MEDLINE, Embase, PsychINFO and CINAHL), which were searched from inception to May 2023. RESULTS Twenty-seven studies including 1662 HCPs, including general practitioners (GPs), physicians, surgeons, physiotherapists (PTs), occupational therapists (OTs), pharmacists and nurses, were included, with identification of six themes: overshadowed as a disease entity, uncertainty in decision making, frustration with interdisciplinary and systemic tension, avoiding medical paternalism, desire for improved care and embracing the responsibility. CONCLUSION Osteoporotic fracture and fall prevention in routine clinical care is hampered by inadequate priority and lack of perceived connection with morbidity and mortality, deficits in interdisciplinary collaboration, lack of clinical confidence and health resourcing. However, HCPs acknowledge their role in promoting healthy ageing, thus providing support through appropriate continuing education, resourcing and public health campaigns that are significant future directions, which may improve osteoporotic fracture prevention.
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Affiliation(s)
- Catherine Cho
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia.
- The Institute of Musculoskeletal Health, Sydney, Australia.
- Concord Repatriation General Hospital, Sydney, Australia.
| | - Grace Bak
- Concord Repatriation General Hospital, Sydney, Australia
| | - Daniel Sumpton
- Concord Repatriation General Hospital, Sydney, Australia
| | - Bethan Richards
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia
- The Institute of Musculoskeletal Health, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - Catherine Sherrington
- Faculty of Health and Medicine, School of Public Health, The University of Sydney, Sydney, Australia
- The Institute of Musculoskeletal Health, Sydney, Australia
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2
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Ahmed S, Farooqui AJ, Pradhan NA, Zehra N, Majid H, Jafri L, Khan AH. Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A national social-media based survey. PLoS One 2023; 18:e0288057. [PMID: 37948412 PMCID: PMC10637646 DOI: 10.1371/journal.pone.0288057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/18/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND There are numerous risk factors for osteoporosis and understanding and recognizing these risk factors is critical when deciding whether to take preventive measures. It is critical to reduce the healthcare expenditure burden of the Pakistani population by raising awareness and implementing osteoporosis-preventable measures. This survey aims to assess the knowledge, attitudes, and practices (KAP) of Pakistani women as well as their misconceptions about osteoporosis. METHODS A cross-sectional survey was conducted from August 2021 to January 2022 by the Bone & Mineral Disease research group at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, with exemption from the ethical review committee. Using snowball sampling, a validated Osteoporosis Prevention and Awareness Tool (OPAAT) was disseminated online via social media. With informed consent, 400 Pakistani women aged ≥ 18 years were included in the study. SPSS Statistics version 25.0 was used for data analysis. Chi-square test for association and Fisher-exact test were applied, and significance level was α<0.05. RESULTS Based on the OPAAT scores of all (n = 400) participants, 22% (n = 88) had low knowledge, 44% (n = 176) had average knowledge, while 34% (n = 136) had good knowledge of osteoporosis. The most common misconceptions were about age-related risk, presentation of symptoms, radiation risk, associated risk factors like tooth loss, osteoarthritis, and knowledge about predictors of bone health. CONCLUSION Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle.
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Affiliation(s)
- Sibtain Ahmed
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Arsala Jameel Farooqui
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Nawazish Zehra
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Hafsa Majid
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Lena Jafri
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
| | - Aysha Habib Khan
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi City, Sindh, Pakistan
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Jones AR, Garth B, Haigh C, Ebeling PR, Teede H, Vincent AJ. Bone health in rural Australia: a mixed methods study of consumer needs. Arch Osteoporos 2023; 18:127. [PMID: 37837494 PMCID: PMC10576660 DOI: 10.1007/s11657-023-01333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
This mixed methods study explores osteoporosis among adults living in a regional area of Victoria, Australia. Three major themes emerged from interviews, which reflected the findings of surveys, concerns regarding the adequacy of care in rural areas, a desire for tailored, local care, and a desire for hybrid telemedicine or in-person services. PURPOSE Osteoporosis or osteopenia affects over half of adults aged over 50 years. People living outside major cities in Australia have higher hip fracture rates than people living in cities, along with reduced access to bone densitometry and osteoporosis specialists. This study explores osteoporosis risk factors, knowledge, experiences of and preferences for care in people living in a regional area, to inform development of osteoporosis care programs. METHODS Adults living in a large non-metropolitan region of Australia were invited to participate in a mixed methods study: a survey (phase 1) followed by semi-structured interviews (phase 2) with triangulation of results. Data collected included osteoporosis diagnosis, risk factors, management, knowledge, preferences for care and experience using telemedicine. Surveys were analysed quantitatively, with linear and logistic regression used to assess factors related to osteoporosis knowledge or satisfaction with telemedicine. Interview transcripts were analysed using thematic analysis by two researchers, with in-depth discussion to identify themes. RESULTS Sixty-two participants completed the survey, and 15 completed interviews. The mean (SD) age of survey participants was 62.2 (14.1) years, 57% had a screening test for osteoporosis, and 12 (19%) had a diagnosis of osteoporosis. The mean osteoporosis knowledge score was 8.4 / 19 and did not differ with age, education, or history of osteoporosis. The majority wanted access to more information about osteoporosis but preferred method differed, and the majority preferred in-person medical consultations to telemedicine. Interview participants were aged between 57 and 87 years, and included 8 with osteoporosis or osteopenia. Three major themes emerged: concerns regarding the adequacy of care in rural areas, a desire for tailored local car and a desire for hybrid telemedicine or in-person services. CONCLUSION Gaps exist in rural osteoporosis care, including knowledge, screening and management. People have differing experiences of care, access to services and preferences for care. High-quality care, tailored to their needs, was preferred. Improving osteoporosis services for regional Australia will require a flexible, multi-faceted approach, addressing needs of the local community and providers.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, Vic, Melbourne, 3068, Australia.
- Department of Endocrinology, Monash Health, Melbourne, Australia.
| | - Belinda Garth
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, Vic, Melbourne, 3068, Australia
- Monash Rural Health Gippsland, Monash University, Traralgon West, Australia
| | - Catherine Haigh
- Monash Rural Health Gippsland, Monash University, Traralgon West, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, Vic, Melbourne, 3068, Australia
- Department of Endocrinology, Monash Health, Melbourne, Australia
- Monash Partner's Academic Health Science Centre, Victoria, Australia
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Locked Bag 29, Clayton, Vic, Melbourne, 3068, Australia
- Department of Endocrinology, Monash Health, Melbourne, Australia
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Nawrat-Szołtysik A, Miodońska Z, Piejko L, Szołtys B, Błaszczyszyn M, Matyja B, Zarzeczny R, Zając-Gawlak I, Kucio E, Polak A. Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111276. [PMID: 34769791 PMCID: PMC8583218 DOI: 10.3390/ijerph182111276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The quality of life in osteoporosis is studied for men rather than for women. Aim of the study was to determine how bone mass density (BMD) relates to life quality components and the severity of pain felt by men affected by osteoporosis. METHODS Presented research is a cross-sectional study. The cohort of 62 men aged 65 to 85 years was divided into a group with osteoporosis (N = 27) and a group without osteoporosis (N = 35). The participants' quality of life was measured with the Qualeffo41 Questionnaire, BMD was quantified by densitometry, and pain intensity was assessed on the Visual Analogue Scale. RESULTS We found that lower BMD was strongly correlated to participants' quality of life (r = -0.72), especially the quality of leisure and social activities (r = -0.66), general health perception (r = -0.59), and mobility (r = -0.57). Pain significantly affected general health perception in older men with osteoporosis. General health assessment and pain were highly correlated with each other (r = 0.888). CONCLUSION BMD and the overall quality of life of the study participants were related to each other. The strongest relationship occurred between reduced BMD and leisure and social activities component. The pain significantly affected participants' general health perception. The results may be employed to create new prophylactic strategies to improve life quality in men with osteoporosis.
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Affiliation(s)
- Agnieszka Nawrat-Szołtysik
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
- Center Saint Elizabeth, 41-700 Ruda Śląska, Poland;
- Correspondence: ; Tel.: +48-793-481-081
| | - Zuzanna Miodońska
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, 41-800 Zabrze, Poland;
| | - Laura Piejko
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
| | - Bogna Szołtys
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
| | - Monika Błaszczyszyn
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-027 Opole, Poland;
| | - Beata Matyja
- Center Saint Elizabeth, 41-700 Ruda Śląska, Poland;
| | - Ryszard Zarzeczny
- Institute of Health Sciences, The Jan Kochanowski University of Kielce, 25-369 Kielce, Poland;
| | - Izabela Zając-Gawlak
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
| | - Ewa Kucio
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
- American Heart of Poland, St. Elizabeth’s Hospital, 40-008 Katowice, Poland
| | - Anna Polak
- Institute of Physiotherapy and Health Sciences, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (L.P.); (B.S.); (A.P.)
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Van Tiem JM, Steffen MJA, Seaman AT, Miller K, Wardyn SE, Richards CC, Solimeo SL. Attitudes toward bone health among rural-dwelling veterans identified as at risk of fracture: a qualitative analysis. JBMR Plus 2021; 5:e10501. [PMID: 34189387 PMCID: PMC8216131 DOI: 10.1002/jbm4.10501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Abstract
Although much is known about system‐level barriers to prevention and treatment of bone health problems, little is known about patient‐level barriers. The objective of this study was to identify factors limiting engagement in bone health care from the perspective of rural‐dwelling patients with known untreated risk. Over 6 months, 39 patients completed a qualitative interview. Interview questions focused on the patient's experience of care, their decision to not accept care, as well as their knowledge of osteoporosis and the impact it has had on their lives. Participants were well‐informed and could adequately describe osteoporosis and its deleterious effects, and their decision making around accepting or declining a dual‐energy x‐ray absorptiometry (DXA) scan and treatment was both cautious and intentional. Decisions about how to engage in treatment were tempered by expectations for quality of life. Our findings suggest that people hold beliefs about bone health treatment that we can build on. Work to improve care of this population needs to recognize that bone health providers are not adding a behavior of medication taking to patients, they are changing a behavior or belief. Published 2021. This article is a U.S. Government work and is in the public domain in the USA. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Jennifer M Van Tiem
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Melissa J A Steffen
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Aaron T Seaman
- VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA.,Department of Internal Medicine Carver College of Medicine, University of Iowa Iowa City Iowa USA
| | - Karla Miller
- Department of Medicine Salt Lake City VA Health Care System Salt Lake City Utah USA.,Division of Rheumatology University of Utah School of Medicine Salt Lake City Utah USA
| | - Shylo E Wardyn
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Christopher C Richards
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA
| | - Samantha L Solimeo
- Veterans Affairs (VA) Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System Iowa City Iowa USA.,VA Health Services Research & Development Service, Center for Access and Delivery Research and Evaluation Iowa City VA Health Care System Iowa City Iowa USA.,Department of Internal Medicine Carver College of Medicine, University of Iowa Iowa City Iowa USA
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Ansari A, Fahimfar N, Noruzi A, Fahimifar S, Hajivalizadeh F, Ostovar A, Larijani B, Sanjari M. Health information-seeking behavior and self-care in women with osteoporosis: a qualitative study. Arch Osteoporos 2021; 16:78. [PMID: 33954873 DOI: 10.1007/s11657-021-00923-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The main findings of this study on the self-care behaviors contain "identification of knowledge gaps," "established networking for seeking information," "information from trust-to-distrust," "information-seeking inhibiting factors," "information-seeking facilitating factors," and "self-care behaviors based on required knowledge." PURPOSE Health information-seeking behavior affects self-care and could promote quality of life and life expectancy. This study aimed at assessing health information-seeking and self-care behaviors of women with osteoporosis in Iran. METHODS This study was conducted using a content analysis approach. Data were collected through semi-structured interviews with 15 women with osteoporosis aged above 50 years. The participants were selected by purposeful sampling. The data were analyzed by the conventional content analysis method using MAXQdata software version 10. RESULTS From in-depth descriptions of the participants' experiences, 246 primary codes were extracted. Subsequently, constant comparison analysis was done and 35 sub-categories and 6 main categories have appeared from the data. DISCUSSION Based on the experiences of women with osteoporosis, they received limited information from the health care providers, so they were seeking reliable information sources to meet their information needs. They obtained most of their information from other patients, family members, and network of friends. In the process of seeking information, they face various barriers such as lack of time in the health care team that affect their ability to self-care. CONCLUSION The results can guide health policymakers, patient educators, health care providers, information specialists, and patients and their families.
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Affiliation(s)
- Ameneh Ansari
- Department of Information Science and Knowledge Studies, Faculty of Management, University of Tehran, Crossroad of Chamran and Jalal Al Ahmad Highway, Next to Tarbiat Modarres Metro Station, Tehran, 1411713114, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al Ahmad Highway, Next to Shariati Hospital, Tehran, 1411713137, Iran
| | - Alireza Noruzi
- Department of Information Science and Knowledge Studies, Faculty of Management, University of Tehran, Crossroad of Chamran and Jalal Al Ahmad Highway, Next to Tarbiat Modarres Metro Station, Tehran, 1411713114, Iran
| | - Sepideh Fahimifar
- Department of Information Science and Knowledge Studies, Faculty of Management, University of Tehran, Crossroad of Chamran and Jalal Al Ahmad Highway, Next to Tarbiat Modarres Metro Station, Tehran, 1411713114, Iran
| | - Fatemeh Hajivalizadeh
- Musculoskeletal Disease Department, Center for Non-Communicable Diseases Prevention and Control, Ministry of Health of Iran, Ministry of Health & Medical Education, Tehran, 14199943471, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al Ahmad Highway, Next to Shariati Hospital, Tehran, 1411713137, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al Ahmad Highway, Next to Shariati Hospital, Tehran, 1411713137, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al Ahmad Highway, Next to Shariati Hospital, Tehran, 1411713137, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Jalal Al Ahmad Highway, Next to Shariati Hospital, Tehran, 1411713137, Iran.
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Birabaharan M, Kaelber DC, Karris MY. Bone Mineral Density Screening Among People With HIV: A Population-Based Analysis in the United States. Open Forum Infect Dis 2021; 8:ofab081. [PMID: 33796595 PMCID: PMC7990062 DOI: 10.1093/ofid/ofab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
HIV infection is associated with premature bone loss. The potential impact of recently updated osteoporosis screening guidelines is unknown. In a population-based cohort, we found low adherence and sex differences among eligible people with HIV.
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Affiliation(s)
- Morgan Birabaharan
- Department of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David C Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
| | - Maile Y Karris
- Department of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
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Paskins Z, Crawford-Manning F, Cottrell E, Corp N, Wright J, Jinks C, Bishop S, Doyle A, Ong T, Gittoes N, Leonardi-Bee J, Langley T, Horne R, Sahota O. Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis. BMJ Open 2020; 10:e040634. [PMID: 33148763 PMCID: PMC7640526 DOI: 10.1136/bmjopen-2020-040634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics. DESIGN A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed. SETTING Any developed country healthcare setting. PARTICIPANTS Patients, healthcare professionals, managers, payers and academics. INTERVENTION Experiences and views of oral and intravenous bisphosphonates. RESULTS Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people's perception of bisphosphonate acceptability. CONCLUSION By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment. PROSPERO REGISTRATION NUMBER CRD42019143526.
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Affiliation(s)
- Zoe Paskins
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Fay Crawford-Manning
- School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | | | - Nadia Corp
- School of Medicine, Keele University, Keele, UK
| | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Simon Bishop
- Centre for Health Innovation, Leadership and Learning, University of Nottingham, Nottingham, UK
| | - Alison Doyle
- Operations and Clinical Practice, Royal Osteoporosis Society, Bath, UK
| | - Terence Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Neil Gittoes
- Centre for Endocrinology Diabetes and Metabolism, University of Birmingham, Birmingham, UK
| | - Jo Leonardi-Bee
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Opinder Sahota
- Department of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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One-third of patients are low-adherent to methotrexate for rheumatoid arthritis at the initiation of a first biologic. A cross-sectional study investigating adherence rate and factors. Joint Bone Spine 2020; 87:668-669. [PMID: 32445934 DOI: 10.1016/j.jbspin.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/30/2020] [Indexed: 11/21/2022]
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