Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey

Bullock, Laurna; Abdelmagid, Sittana; Fleming, Jane; Leyland, Sarah; Clark, Emma M.; Gidlow, Christopher; P. Iglesias-Urrutia, Cynthia; O’Neill, Terence W.; Mallen, Christian; Jinks, Clare; Paskins, Zoe

Abstract

Summary
We conducted a survey of FLSs’ consultation conduct and content which identified marked variation in whether FLS HCPs discussed osteoporosis medicine with patients. A review of service pro formas showed more content related to ‘investigating’ and ‘intervening’ than to ‘informing’. We propose an expanded FLS typology and model FLS pro forma.

Purpose
To investigate the nature of direct patient contact in fracture liaison service (FLS) delivery, examine the use and content of pro formas to guide information eliciting and sharing in FLS consultations, and determine service changes which were implemented as a result of the COVID-19 pandemic.

Methods
An electronic survey of UK FLS healthcare practitioners (HCPs) was distributed through clinical networks, social media, and other professional networks. Participants were asked to upload service pro formas used to guide consultation content. Documentary analysis findings were mapped to UK FLS clinical standards.

Results
Forty-seven HCPs responded, providing data on 39 UK FLSs, over half of all 74 FLSs reporting to FLS-database. Results showed variation in which HCP made clinical decisions, whether medicines were discussed with patients or not, and in prescribing practice. Services were variably affected by COVID, with most reporting a move to more remote consulting. The documentary analysis of eight service pro formas showed that these contained more content related to ‘investigating’ and ‘intervening’, with fewer pro formas prompting the clinician to offer information and support (e.g., about coping with pain). Based on our findings we propose an expanded FLS typology and have developed a model FLS pro forma.

Conclusion
There is marked variation in the delivery of services and content of consultations in UK FLSs including discussion about osteoporosis medications. Clinical standards for FLSs should clarify the roles of primary and secondary HCPs and the importance of holistic approaches to patient care.

Citation

Bullock, L., Abdelmagid, S., Fleming, J., Leyland, S., Clark, E. M., Gidlow, C., …Paskins, Z. (2023). Variation in UK fracture liaison service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey. Archives of Osteoporosis, 19(1), Article 5. https://doi.org/10.1007/s11657-023-01361-4

• Journal Article Type: Article
• Acceptance Date: Nov 30, 2023
• Online Publication Date: Dec 20, 2023
• Publication Date: Dec 20, 2023
• Deposit Date: Dec 21, 2023
• Journal: Archives of Osteoporosis
• Print ISSN: 1862-3522
• Electronic ISSN: 1862-3514
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 1
• Article Number: 5
• DOI: https://doi.org/10.1007/s11657-023-01361-4
• Keywords: Orthopedics and Sports Medicine; Fracture liaison service; iFraP; Survey; Osteoporosis; Shared decision-making
• Additional Information: Received: 26 September 2023; Accepted: 30 November 2023; First Online: 20 December 2023; : ; : Ethical permission for the study was given by North West—Greater Manchester West Research Ethics Committee (reference number: 19/NW/0559).; : Informed consent was obtained from all individual participants included in the study.; : Dr Zoe Paskins has received consultancy fees from UCB for a non-promotional advisory board. Dr Laurna Bullock, Sittana Abdelmagid, Dr Jane Fleming, Sarah Leyland, Prof Emma M Clark, Prof Christopher Gidlow, Prof Cynthia P Iglesias-Urrutia, Prof Terence W O’Neill, Prof Christian Mallen and Prof Clare Jinks declare that they have no conflict of interest.; : This study presents independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care.