Cultivating across “pockets of excellence”: challenges to sustaining efforts to improve osteoporosis care
- 19.08.2021
- Original Article
Erschienen in:
- Verfasst von
- Aaron T. Seaman
- Melissa J. A. Steffen
- Jennifer M. Van Tiem
- Shylo Wardyn
- Xiomara Santana
- Karla L. Miller
- Samantha L. Solimeo
- Erschienen in
- Osteoporosis International | Ausgabe 1/2022
Abstract
Summary
We conducted in-depth, semi-structured interviews with clinicians involved in bone health care to understand the challenges of implementing and sustaining bone health care interventions. Participants identified individual- and system-level challenges to care delivery, implementation, and sustainment. We discuss opportunities to address challenges through a commitment to relationship- and infrastructure-building support.
Purpose
Osteoporosis and fracture-related sequalae exact significant individual and societal costs; however, identification and treatment of at-risk patients are troublingly low, especially among men. The purpose of this study was to identify challenges to implementing and sustaining bone health care delivery interventions in the Veterans Health Administration.
Methods
We conducted interviews with endocrinologists, pharmacists, primary care physicians, rheumatologists, and orthopedic surgeons involved in bone health care (n = 20). Interviews were audio-recorded and transcribed verbatim. To determine thematic domains, we engaged in an iterative, qualitative content analysis of the transcripts.
Results
Participants reported multiple barriers to delivering bone health care and to sustaining the initiatives designed to address delivery challenges. Challenges of bone health care delivery existed at both the individual level—a lack of patient and clinician awareness and competing clinical demands—and the system level—multiple points of entry to bone health care, a dispersion of patient management, and guideline variability. To address the challenges, participants developed initiatives targeting the identification of at-risk patients, clinician education, increasing communication, and care coordination. Sustaining initiatives, however, was challenged by staff turnover and the inability to achieve and maintain priority status for bone health care.
Conclusion
The multiple, multi-level barriers to bone health care affect both care delivery processes and sustainment of initiatives to improve those processes. Barriers to care delivery, while tempered by intervention, are entangled and persist alongside sustainment challenges. These challenges require relationship- and infrastructure-building support.
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- Titel
- Cultivating across “pockets of excellence”: challenges to sustaining efforts to improve osteoporosis care
- Verfasst von
-
Aaron T. Seaman
Melissa J. A. Steffen
Jennifer M. Van Tiem
Shylo Wardyn
Xiomara Santana
Karla L. Miller
Samantha L. Solimeo
- Publikationsdatum
- 19.08.2021
- Verlag
- Springer London
- Erschienen in
-
Osteoporosis International / Ausgabe 1/2022
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965 - DOI
- https://doi.org/10.1007/s00198-021-06098-9
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