NHS Education for Scotland, Edinburgh, UK.
University of Strathclyde, Glasgow, UK.
BMJ Open. 2024 Nov 2;14(11):e085323. doi: 10.1136/bmjopen-2024-085323.
Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol.
We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team.
Ethical approval was obtained from NHS North West-Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.
骨质疏松症患者的药物依从性较差，估计 1 年的持续率在 16%至 60%之间。依从性差是复杂的，与对副作用的恐惧、对药物不必要的信念、对疗效的怀疑以及药物管理的负担有关。由于缺乏监测，许多患者在初始处方后实际上已从持续护理中出院，这使得情况更加复杂。临床药师在英国国民保健制度中是一个相对较新的工作群体；这是一个尚未被探索的专业群体，可以在骨质疏松症的背景下提供以患者为中心、以药物依从性为重点的干预措施。本方案将使用现有证据和理论以及经验性定性工作，为已经开 fracture prevention 药物的患者制定由临床药师在全科实践中实施的模型咨询干预措施。
我们将通过与骨质疏松症患者、药剂师、全科医生、骨质疏松症专家和服务设计者/管理者进行焦点小组讨论，调查临床药师主导的骨质疏松症干预的现行做法以及障碍和促进因素，包括探索培训需求。框架分析将确定和优先考虑重要主题，然后将代码映射到理论领域框架和规范化过程理论，以了解整合和实施问题。我们将通过与利益相关者和患者及公众参与和参与小组成员进行共同设计研讨会，进一步制定新咨询干预措施的内容和护理模式。该实践中的干预措施将通过与处方 fracture prevention 药物的患者、药剂师和多学科团队进行研讨会和现场测试进行逐步改进。
NHS 西北-大曼彻斯特南部研究伦理委员会已获得伦理批准（Ref 23/NW/0199）。通过一系列国家机构/利益相关者将促进传播和知识转移。影响和实施计划将加速这项研究，以进行未来的临床试验，以确定成本和临床效果。
