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Supporting patients to get the best from their osteoporosis treatment: a rapid realist review of what works, for whom, and in what circumstance

Paskins, Zoe; Babatunde, Opeyemi; Sturrock, A.; Toh, L.S.; Horne, R.; Maidment, I.; Royal Osteoporosis Society, Effectiveness Working Group of the; Research Academy, Osteoporosis Bone; McCloskey, Eugene; Armstrong, David; Curtis, Elizabeth; Edwards, John; Javaid, Kassim; Hill, Thomas; O’Neill, Terry; Stone, Michael; Walsh, Jennifer; McKinley, Janice; Turnbull, Corinne; Compston, Juliet; Harvey, Nick; Reid, David; Vine, Nic; Bishop, Mary

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Authors

A. Sturrock

L.S. Toh

R. Horne

I. Maidment

Effectiveness Working Group of the Royal Osteoporosis Society

Osteoporosis Bone Research Academy

Eugene McCloskey

David Armstrong

Elizabeth Curtis

John Edwards

Kassim Javaid

Thomas Hill

Terry O’Neill

Michael Stone

Jennifer Walsh

Janice McKinley

Corinne Turnbull

Juliet Compston

Nick Harvey

David Reid

Nic Vine

Mary Bishop



Abstract

Systematic reviews that examine effectiveness of interventions to improve medicines optimisation do not explain how or why they work. This realist review identified that interventions which effectively optimise medicines use in osteoporosis include opportunities to address patients' perceptions of illness and treatment and/or support primary care clinician decision making. INTRODUCTION: In people with osteoporosis, adherence to medicines is poorer than other diseases and patients report follow-up is lacking, and multiple unmet information needs. We conducted a rapid realist review to understand what contextual conditions and mechanisms enable interventions to support osteoporosis medication optimisation. METHODS: A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation; a supplementary second search identified research of any design to gain additional insights on emerging findings. Extracted data was interrogated for patterns of context-mechanism-outcome configurations, further discussed in team meetings, informed by background literature and the Practicalities and Perception Approach as an underpinning conceptual framework. RESULTS: We identified 5 contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine). Interventions which support patient-informed decision making appear to influence long-term commitment to treatment. Supporting patients' practical ability to adhere (e.g. by lowering treatment burden and issuing reminders) only appears to be helpful, when combined with other approaches to address patient beliefs and concerns. However, few studies explicitly addressed patients' perceptions of illness and treatment. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. CONCLUSIONS: We identified a need for further research to identify a sustainable, integrated, patient-centred, and cost- and clinically effective model of long-term care for people with osteoporosis.

Journal Article Type Article
Acceptance Date May 28, 2022
Online Publication Date Jun 11, 2022
Publication Date 2022-11
Publicly Available Date May 30, 2023
Journal Osteoporosis International
Print ISSN 0937-941X
Publisher Springer Verlag
DOI https://doi.org/10.1007/s00198-022-06453-4
Keywords osteoporosis treatment; realist review; medicines optimisation
Publisher URL https://link.springer.com/article/10.1007/s00198-022-06453-4#article-info

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