Aim Osteoporosis is a major risk factor for fractures. Poor persistence with osteoporosis medication hampers outcomes. This study assessed whether encouraging the formation of patient‐led follow‐up cooperatives between general practitioners (GPs) and community pharmacists improved medication persistence. Methods All consecutive patients who attended an osteoporosis patient education program were invited to participate. They were given a logbook containing questionnaires they would bring to 6‐monthly visits to their GP and pharmacist. The effect of this 3‐year cooperative follow‐up on persistence with medication and lifestyle changes was assessed. Results In total, 121 patients (average age, 67 years; 93% female) participated. Poor cooperation between GPs and pharmacists was noted. Nevertheless, medication persistence ranged from 83% to 91% over the 6 visits. However, since patient drop‐out rates were high and questionnaire return rates were low, a post‐study medical chart review was performed. This confirmed that persistence was high (74%‐83%) at 3 years post‐enrollment, even for oral bisphosphonate‐treated patients (73%‐76%). However, adoption of anti‐osteoporosis lifestyle changes was poor throughout the study: one‐ to two‐thirds of the patients did not alter their diet, physical activity, or surroundings to prevent falls. Conclusion One study goal, namely, to encourage GPs and pharmacists to cooperate in patient follow‐up, was not achieved. However, high medication persistence was observed. This may reflect the education program, patient empowerment, personalized attention from study personnel, and being in a study. Patient‐centered approaches can thus significantly increase medication persistence in osteoporosis. Ongoing education may be needed to improve patient adoption of and persistence with lifestyle changes.

Background The treatment of osteoporosis requires regular medication for almost 3 years and a change of lifestyle. Adherence drops to 50% after one year, the change in lifestyle fraught with entrenched habits. Objectives Programs of therapeutic patient education (TPE) find naturally their place in improving adherence, the acquisition of sufficient calcium-rich diet and regular patient-tailored physical activity. Methods We have gathered 2 rheumatologists, a chemist, a dietitian, a specialist for physical balance and 2 representatives of a patient association (AFLAR) to develop a program of TPE.After one year, we have identified three main objectives: to ensure maximun adherence to treatment, to ensure the capture of four dairy products a day and to engage patients into various customized workshops so as to increase their physical activities and/or to improve their balance on the ground.We gathered six to seven patients during 3 hours, if possible accompanied by their husband. We have developed games to stimulate the cooperation and the exchange with/between patients and make understanding and acquisiton goals easier.Further to an educational diagnosis collected by questionnaire and individual interview, the session includes a game of the goose for the explanation and the understanding of osteoporosis, how to sort fake food with or without calcium, a questionnaire for calcium intake before and after correction of the deficits, a coffee break with yogurt, a puzzle of healthy bones and osteoporotic bones with parts labeled according to risk factors, exchange about physical activities and how to maintain physical balance. Six months later, we sent a questionnaire to participants to determine their adherence to treatment, and if proper calcium intake and physical activities were maintained. The data were processed by EpiData3,1 and Epi info 3,5,3 Results We spoke to 44 female patients taking oral medication of biphosphonate gathered in sessions of 5 to 6 patients,30% of them being accompanied.We obtained 35 responses: 100% kept on taking their treatment, 29/35 never forgot it, 4/35 rarely forgot it and 2 forgot it often.32/35 patients considered it useful to prevent fractures, 13 to avoid decreasing in size, 12 to keep their autonomy.Only 27/35 were aware of the need to take it a over long time. 20/35 had changed their diet, 35/35 quoted 4 dairy products, 15/35 (4 falling and 11 not falling) have taken precautions to avoid falling. One patient who had fallen did not do anyting to avoid falling, 6 patients both had modified their alimentation and took measures not to fall. Half of them engaged in a physical exercise program and how to keep physical balance which allows no to fall. Conclusions For the respondants of the questionnaire (35/44), TPE is effective on adherence to treatment, dietary calcium intake,taking precautions against falls, as well as the notion of multi-year follow-up treatment is not always assimilated.The use of games, the presence of the husband, and adoption of time schedules tailored to the el...

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BackgroundThe management of osteoporosis requires a restrictive drug treatment over several years and lifestyle changes: maintaining a suitable physical activity, a sufficient calcium intake and maintenance of ground balance. Unfortunately, treatment adherence at one year doesn’t exceed 50%. The education of the patient allows to take care of himself in his therapeutic approach but requires a relay to continue the follow-up over several years.ObjectivesTo improve the follow-up of the patient, we created a cooperation between the doctor and the pharmacist.MethodsWe suggested to patients treated for osteoporosis by diphosphonate, denosumab or teriparatide to participate at two half-day TPE sessions, one year apart. It’s taught that osteoporosis requires at least 5 years of treatment, and must be associated with the absorption of three daily dairy products, maintaining physical activity and preventing falls.A follow-up notebook that contains 6 doctor and 6 pharmacist questionnaires is given to each patient participating in a TPE session. The patient sends his book to the doctor, and then to the pharmacist twice a year for three years. The pharmacist questionnaire explains the drug intake. The doctor questionnaire evokes lifestyle changes. This one is completed by the patient in the waiting room and is discussed with the doctor during the consultation. Each completed questionnaire provides a financial compensation to the health professional.The program is funded by the Regional Health Agence of Lorraine and by the Regional Union of Health Professionals (doctors and pharmacists). Inclusions started in January 2013. We studied the results of the 3 year questionnaires for 94 patients included in 2013 and 2014.ResultsAmong the 94 patients, only 49 continue their treatment at 3 years. Patients who stopped treatment, 4 died, 1 presented an atypical fracture of the femoral shaft, 6 stopped due to dental treatment, 4 had a contraindication to any anti-osteoporosis treatment, 1stopped treatment due to multiple sclerosis 11 left the program, 2 had poorly tolerated the infusion and 1 discontinued treatment because of improved bone mineral density (BMD). Among the 49 patients who continue their treatment, 13 returned a doctor and pharmacist questionnaire at 3 years. There are 4 doctors and 2 pharmacists who refused to fill out the questionnaire, 20 patients didn’t agree to respond to our request for news about their health condition and 4 patients lost to follow-up.The study of 13 questionnaires received shows that at 3 years, 38% of patients continue to consume 3 daily dairy products against 56% at 6 months. Nearly 70% of patients maintained their physical activity, 8% improved and 8% decreased it. It also shows that 46% of patients walk more than 30 min per day. The ground balance is satisfactory for 62% of patients compared to 71% at 6 months. Regarding compliance, at 6 months and 3 years, only 69% of patients never forget their treatment and 15% wanted to stop it. During the 3 years of follow-up, all patients were re-contacte...

BackgroundThe adherence to osteoporosis'medication don't exceed 50% at one year.ObjectivesTo improve patient's follow up care and adhesion thanks to the creation of a cooperation between the general physician and the dispensary pharmacist and to shown levers and obstacles of a successful cooperation between general physician and dispensary pharmacist in order to improve patients' compliance.MethodsEach patient is asked to participate in a therapeutic education session and receive a follow-up care's logbook containing 6 questionnaires to be completed by the physician and 6 questionnaires to be completed by the pharmacist. The questionnaire “physician” broaches lifestyles' changes, the questionnaire “pharmacist” approaches drugs intake. The patient should pass his logbook to his general physician and his dispensary pharmacist twice a year during 3 years.One meeting a year is organized between physicians and pharmacists to update the protocol, address current diagnosis and therapeutics alternatives.The inclusions started in January 2013 and questionnaires' results were studied at 6 months and 1 year. We interviewed 10 physicians and 10 pharmacists for a semi-directed meeting to assess obstacles and levers of interprofessional cooperationResultsThe setting up of a “physician/pharmacist” team should be made by peer-to-peer knowledge. The main levers which gathers the team of experts are annual coordination meeting, follow-up care's logbook. Also an important factor is the patient himself who should be active and framed. Nevertheless, this study highlights two major hard controlled obstacles: the geographical remoteness and the lack of time. Treatment compliance: 49 patients were included in 2013. Every patient received complete information about the treatment and knows exactly its use. 65 among them are still continuing their treatment after 1 year of whom 8 hadn't give back their questionnaires. The analysis of the 27 received questionnaires (at 1 year) shows a rate of compliance with medicinal treatments of 100%, a sufficient supply of dietary calcium's rate of 85% versus 74% after 6 months. It also revealed a sufficient ground balance of 92% versus 77% after 6 months. 96% of these patients comply with the treatment intake's terms, 92% respected the treatment completion versus 75% after 6 months and 89% of them know what to do in case they've forget their treatment. We recorded that 21% of the patients had wanted to stop their treatment due to secondary effects, constraints too important or lake of perceptible effects, versus 9% after 6 months but they didn't stop after a physician or pharmacist consult. 68% of patients know the duration of the treatment. Concerning their lifestyle, we noted that 11% of the patients improved their physical activity level and 78% remained at the same level they were before. Questionnaires' results showed that 56% of the patients expressed their concern about osteoporosis.Six patients stopped the treatment after secondary effects appeared (e.g: dental, ophthalmologic complications)Four...