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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Making the case for a fracture liaison service: a qualitative study of the experiences of clinicians and service managers

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Sarah Drew, Rachael Gooberman-Hill, Andrew Farmer, Laura Graham, M Kassim Javaid, Cyrus Cooper, Andrew Judge, The REFReSH study group
Wichtige Hinweise

Competing interests

MKJ has received in the last 5 years honoraria for travel expenses, speaker fees and/or advisory committees from Lilly UK, Amgen, Servier, Merck, Medtronic, Internis and Consilient Health. He also serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation; CC has received consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche; AJ has held advisory board positions (which involved receipt of fees) with Anthera Pharmaceuticals and Servier, and received consortium research grants from ROCHE.
SD, RGH, AF, LG have no conflicts of interest to report.

Authors’ contributions

AJ, RGH, KJ, CC and all of The REFReSH Study Group contributed to the design of this research. SD, RGH, AF, LG, KJ, CC, AJ all contributed to the acquisition, analysis, or interpretation of data. All authors contributed to drafting this work and revising it for important intellectual content and all gave final approval for the version to be submitted. RGH is guarantor.



To develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Patients with hip fracture are at high risk of subsequent fracture. To prevent this, guidance recommends structuring fracture prevention services around coordinator based models. These are known as Fracture Liaison Services (FLS).


33 semi-structured qualitative interviews were conducted with healthcare professionals with experience of making business cases for FLS. Data was analysed thematically.


Challenges in the development of business cases included collecting all the relevant data and negotiating compartmentalised budgets that impeded service development. Participants described communication and cooperation between providers and commissioners as variable. They felt financial considerations were the most important factor in funding decisions, while improved quality of care was less influential. Other factors included national guidelines and political priorities. The personalities of clinicians championing services, and the clinical interests of commissioners were seen to influence the decision-making process, suggesting that participants felt that decisions were not always made on the basis of evidence-based care. Effective strategies included ways of providing support, demonstrating potential cost effectiveness and improved quality of care. Using a range of sources including audit data collected on the successful Glasgow FLS, and improving cooperation between stakeholders was advocated. Participants felt that the work of commissioners and providers should be better integrated and suggested strategies for doing this.


This study provides information to healthcare professionals about how best to develop business cases for FLS. We conclude with recommendations on how to develop effective cases. These include using guidance such as toolkits, aligning the aims of FLS with national priorities and benchmarking services against comparators. Introducing a ‘Local Champion’ to work alongside the service manager and establishing a multi-disciplinary working team would facilitate communication between stakeholders. Involving commissioners in service design would help integrate the roles of purchasers and providers.
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