Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice
Abstract Background Among Australians aged 50 and over, an estimated 1 in 4 men and 2 in 5 women will experience a minimal trauma fracture during their remaining lifetime. Effective fracture prevention is hindered by substantial undertreatment, even of patients who clearly warrant pharmacological th...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Family Practice |
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| Online Access: | https://doi.org/10.1186/s12875-020-01103-2 |
| _version_ | 1818240966867288064 |
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| author | Pradnya Naik-Panvelkar Sarah Norman Zain Elgebaly Jeff Elliott Allan Pollack Jill Thistlethwaite Clare Weston Markus J. Seibel |
| author_facet | Pradnya Naik-Panvelkar Sarah Norman Zain Elgebaly Jeff Elliott Allan Pollack Jill Thistlethwaite Clare Weston Markus J. Seibel |
| author_sort | Pradnya Naik-Panvelkar |
| collection | DOAJ |
| description | Abstract Background Among Australians aged 50 and over, an estimated 1 in 4 men and 2 in 5 women will experience a minimal trauma fracture during their remaining lifetime. Effective fracture prevention is hindered by substantial undertreatment, even of patients who clearly warrant pharmacological therapy. Poor adherence to osteoporosis treatment is also a leading cause of repeat fractures and hospitalisation. The aim of this study was to identify current osteoporosis treatment patterns and gaps in practice in Australia, using general practice data, and to explore general practitioners’ (GPs’) attitudes to osteoporosis treatment and their views on patient factors affecting osteoporosis management. Methods The study was conducted in two phases. Phase 1 was a longitudinal retrospective cohort study which utilised data from MedicineInsight – a national general practice data program that extracts longitudinal, de-identified patient data from clinical information systems (CISs) of participating general practices. Phase 2 included semi-structured, in-depth telephone interviews with a sample of MedicineInsight practice GPs. Data were analysed using an inductive thematic analysis method informed by the theory of planned behaviour. Results A diagnosis of osteoporosis was recorded in 12.4% of patients over the age of 50 years seen in general practice. Of those diagnosed with osteoporosis, almost a quarter were not prescribed osteoporosis medicines. From 2012 to 17, there was a progressive increase in the number of denosumab prescriptions, while prescriptions for bisphosphonates and other osteoporosis medicines decreased. More than 80% of patients who ceased denosumab treatment had no subsequent bisphosphonate prescription recorded. Interviews with GPs revealed beliefs and attitudes that may have influenced their intentions towards prescribing and osteoporosis management. Conclusions This study suggests that within the Australian general practice setting, osteoporosis is underdiagnosed and undertreated. In addition, it appears that most patients who ceased denosumab treatment had no record of subsequent antiresorptive therapy, which would place them at risk of further fractures. The study supports the need for the development of clinical education programs addressing GP knowledge gaps and attitudes, and the implementation of specific interventions such as good reminder/recall systems to avoid delays in reviewing and treating patients with osteoporosis. |
| first_indexed | 2024-12-12T13:21:51Z |
| format | Article |
| id | doaj.art-5099a2eb004b414cb90f8dc9e75794dd |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-12T13:21:51Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-5099a2eb004b414cb90f8dc9e75794dd2022-12-22T00:23:16ZengBMCBMC Family Practice1471-22962020-02-0121111310.1186/s12875-020-01103-2Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practicePradnya Naik-Panvelkar0Sarah Norman1Zain Elgebaly2Jeff Elliott3Allan Pollack4Jill Thistlethwaite5Clare Weston6Markus J. Seibel7NPS MedicineWiseNPS MedicineWiseNPS MedicineWiseNPS MedicineWiseNPS MedicineWiseNPS MedicineWiseNPS MedicineWiseDepartment of Endocrinology & Metabolism, Concord Repatriation General Hospital, The University of Sydney and Bone Research Program, ANZAC Research InstituteAbstract Background Among Australians aged 50 and over, an estimated 1 in 4 men and 2 in 5 women will experience a minimal trauma fracture during their remaining lifetime. Effective fracture prevention is hindered by substantial undertreatment, even of patients who clearly warrant pharmacological therapy. Poor adherence to osteoporosis treatment is also a leading cause of repeat fractures and hospitalisation. The aim of this study was to identify current osteoporosis treatment patterns and gaps in practice in Australia, using general practice data, and to explore general practitioners’ (GPs’) attitudes to osteoporosis treatment and their views on patient factors affecting osteoporosis management. Methods The study was conducted in two phases. Phase 1 was a longitudinal retrospective cohort study which utilised data from MedicineInsight – a national general practice data program that extracts longitudinal, de-identified patient data from clinical information systems (CISs) of participating general practices. Phase 2 included semi-structured, in-depth telephone interviews with a sample of MedicineInsight practice GPs. Data were analysed using an inductive thematic analysis method informed by the theory of planned behaviour. Results A diagnosis of osteoporosis was recorded in 12.4% of patients over the age of 50 years seen in general practice. Of those diagnosed with osteoporosis, almost a quarter were not prescribed osteoporosis medicines. From 2012 to 17, there was a progressive increase in the number of denosumab prescriptions, while prescriptions for bisphosphonates and other osteoporosis medicines decreased. More than 80% of patients who ceased denosumab treatment had no subsequent bisphosphonate prescription recorded. Interviews with GPs revealed beliefs and attitudes that may have influenced their intentions towards prescribing and osteoporosis management. Conclusions This study suggests that within the Australian general practice setting, osteoporosis is underdiagnosed and undertreated. In addition, it appears that most patients who ceased denosumab treatment had no record of subsequent antiresorptive therapy, which would place them at risk of further fractures. The study supports the need for the development of clinical education programs addressing GP knowledge gaps and attitudes, and the implementation of specific interventions such as good reminder/recall systems to avoid delays in reviewing and treating patients with osteoporosis.https://doi.org/10.1186/s12875-020-01103-2OsteoporosisPrimary careTreatment patternsPractice gapsGP perspectivesBisphosphonates |
| spellingShingle | Pradnya Naik-Panvelkar Sarah Norman Zain Elgebaly Jeff Elliott Allan Pollack Jill Thistlethwaite Clare Weston Markus J. Seibel Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice BMC Family Practice Osteoporosis Primary care Treatment patterns Practice gaps GP perspectives Bisphosphonates |
| title | Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice |
| title_full | Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice |
| title_fullStr | Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice |
| title_full_unstemmed | Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice |
| title_short | Osteoporosis management in Australian general practice: an analysis of current osteoporosis treatment patterns and gaps in practice |
| title_sort | osteoporosis management in australian general practice an analysis of current osteoporosis treatment patterns and gaps in practice |
| topic | Osteoporosis Primary care Treatment patterns Practice gaps GP perspectives Bisphosphonates |
| url | https://doi.org/10.1186/s12875-020-01103-2 |
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