Perceptions and practices of aged care pharmacists regarding osteoporosis management: a qualitative study

Abstract

Background Osteoporosis is a common but sub-optimally managed disease among aged care residents. Although pharmacists are one of the key healthcare providers responsible for osteoporosis medication management there is limited research on their involvement. Aim This study explored the perceptions and practices of Australian pharmacists regarding osteoporosis management for aged care residents. Method Semi-structured interviews were conducted with aged care pharmacists. Interviews were recorded, transcribed, and analysed using a constructivist grounded theory approach. Results Twenty-one aged care pharmacists were interviewed. Three main themes were identified: osteoporosis is highly prevalent but given low priority, factors affecting pharmacists’ management of osteoporosis, and optimism for the future role of pharmacists in osteoporosis management. The complexity of aged care residents’ healthcare needs and the silent, insidious nature of osteoporosis contribute to the low priority it is afforded. Barriers identified by pharmacists included their current practice model, limited access to residents’ medical histories and difficulties accessing bone mineral density (BMD) testing. Interdisciplinary collaboration and education regarding osteoporosis management were seen as facilitators. Pharmacists were optimistic that an embedded practice model would improve their capacity to influence osteoporosis management. Conclusion The high prevalence and low priority of osteoporosis in the aged care setting presents pharmacists with an opportunity to improve medication management and reduce fracture risk. Barriers to osteoporosis management identified by pharmacists can be addressed by interdisciplinary collaboration and education. Pharmacists being embedded in aged care could enable more opportunities to contribute to the interdisciplinary team and become champions of osteoporosis management.

Osteoporosis management in Australian aged care facilities: a mixed method study

“…However, this is significantly lower than the estimated 80–85% prevalence rate based on BMD testing of aged care residents [ 2 ]. A potential contributing factor to underdiagnosis is that of incomplete medical histories being provided to aged care facilities at the time of resident admission [ 10 ]. The finding that 41.7% of residents receiving antiresorptive therapy did not have osteoporosis in their diagnosis list supports the notion that incomplete medical histories are a common occurrence for aged care residents.…”

“…Several reasons for the sub-optimal management of osteoporosis in aged care have been proposed [ 4 , 5 , 10 , 11 ]. These include a change of healthcare providers on admission to the aged care facility, a strong emphasis on deprescribing rather than the commencement of therapy, and difficulties in diagnostic testing in this population [ 4 , 5 , 10 , 11 ].…”

“…An Australian study reported 72.2% of residents had a change of general practitioner upon admission, whilst a Canadian study similarly reported that only 12.1% of residents retained their family physician [ 12 , 13 ]. Receipt of incomplete medical histories by the new care team can lead to disruptions in osteoporosis management [ 10 , 14 ].…”

“…The multiple comorbidities and frailty of aged care residents make them highly susceptible to adverse drug reactions, leading to a reported emphasis on deprescribing opportunities [ 15 ]. This focus on deprescribing, rather than prescribing, is linked to a hesitance to investigate and commence therapy for chronic conditions such as osteoporosis [ 10 , 11 ]. Treatment commencement is further impeded by the logistical challenges associated with undertaking bone mineral density (BMD) testing using dual-energy X-ray absorptiometry (DEXA) for aged care residents, resulting in underdiagnosis [ 10 , 11 , 16 ].…”

“…This focus on deprescribing, rather than prescribing, is linked to a hesitance to investigate and commence therapy for chronic conditions such as osteoporosis [ 10 , 11 ]. Treatment commencement is further impeded by the logistical challenges associated with undertaking bone mineral density (BMD) testing using dual-energy X-ray absorptiometry (DEXA) for aged care residents, resulting in underdiagnosis [ 10 , 11 , 16 ]. This gives rise to the recommendation that fracture risk assessments be undertaken for all aged care residents and used to guide treatment without needing a BMD test [ 4 , 14 , 16 – 18 ].…”