Bennett Michael J, Center Jacqueline R, Carter Stephen, Moles Rebekah, Perry Lin
Department of Endocrinology, Prince of Wales Hospital, Randwick, NSW, Australia.
Department of Endocrinology, Sutherland Hospital, Caringbah, NSW, Australia.
Osteoporos Int. 2025 Jul 1. doi: 10.1007/s00198-025-07589-9.
Home medicines reviews present a novel intervention supporting continuity of care between fracture liaison services and primary care. Home medicines review pharmacists deliver multifaceted, collaborative interventions that can bridge gaps in care, promote patient empowerment, facilitate a GP-patient discussion about bone health, and improve coordination of care.
Medication review has potential to reduce the risk of falls and fractures and improve transition of care from a specialist fracture liaison service to primary care. This study was designed to examine and evaluate the implementation of a home medicines review into fracture liaison services in Australia. Study objectives were to (1) explore how home medicines reviews might facilitate the healthcare transition from fracture liaison service to primary care and (2) identify factors required to achieve this.
This was a qualitative descriptive study nested within a randomised trial (reported elsewhere). Semi-structured interviews were conducted with patients and healthcare practitioners responsible for providing osteoporosis services. Formative and early-stage data collection occurred September 2022 to January 2024. Thematic analysis was employed inductively (data-driven) and directed content analysis was applied deductively (theory-driven) using the consolidated framework for implementation research (CFIR) domains to frame factors affecting home medicines review implementation.
Fifty-six interviews were performed: 25 with pharmacists, 14 with fracture liaison service clinicians, seven with GPs, and ten with patients. Participants perceived home medicines review pharmacists to be uniquely positioned to favourably influence the transition to primary care by (1) identifying gaps in care, (2) promoting patient empowerment, (3) facilitating a GP-patient discussion about bone health, and (4) improving coordination of care. Factors affecting home medicines review implementation related to CFIR domains of the individuals (patient and GP engagement and willingness to accept advice, patient preparedness, GP confidence deprescribing), the innovation (hospital endorsement of home medicines review reports, perception of intervention value, embedded administrative assistants, pharmacist expertise), the inner setting (role clarity, multidisciplinary teamwork culture, and patient-centred focus, scheduling practices, and communication systems), and outer setting (access to telehealth services, a network of mobile pharmacists, and appropriate remuneration systems).
Home medicines review pharmacists delivering multifaceted, collaborative, and patient-centred interventions can support effective transition of care between fracture liaison services and primary care. Further work should test their integration into fracture liaison service models within routine care environments.
家庭药物审查是一种新的干预措施，有助于骨折联络服务与初级保健之间的护理连续性。家庭药物审查药剂师提供多方面的协作干预措施，可以弥合护理差距，促进患者自主，推动全科医生与患者就骨骼健康进行讨论，并改善护理协调。
药物审查有可能降低跌倒和骨折风险，并改善从专科骨折联络服务向初级保健的护理过渡。本研究旨在检查和评估澳大利亚骨折联络服务中家庭药物审查的实施情况。研究目标是：（1）探讨家庭药物审查如何促进从骨折联络服务到初级保健的医疗保健过渡；（2）确定实现这一目标所需的因素。
这是一项嵌套在随机试验中的定性描述性研究（其他地方有报告）。对负责提供骨质疏松症服务的患者和医疗保健从业者进行了半结构化访谈。2022年9月至2024年1月进行了形成性和早期数据收集。采用归纳法（数据驱动）进行主题分析，并使用实施研究综合框架（CFIR）领域进行演绎法（理论驱动）定向内容分析，以确定影响家庭药物审查实施的因素。
进行了56次访谈：25次与药剂师，14次与骨折联络服务临床医生，7次与全科医生，10次与患者。参与者认为家庭药物审查药剂师具有独特的地位，可以通过以下方式对向初级保健的过渡产生积极影响：（1）识别护理差距；（2）促进患者自主；（3）推动全科医生与患者就骨骼健康进行讨论；（4）改善护理协调。影响家庭药物审查实施的因素与CFIR的个人领域（患者和全科医生的参与度和接受建议的意愿、患者的准备情况、全科医生减少用药的信心）、创新（医院对家庭药物审查报告的认可、对干预价值的认知、嵌入式行政助理、药剂师专业知识）、内部环境（角色明确、多学科团队合作文化、以患者为中心的重点、排班做法和沟通系统）以及外部环境（获得远程医疗服务、流动药剂师网络和适当的薪酬系统）有关。
提供多方面、协作性和以患者为中心干预措施的家庭药物审查药剂师可以支持骨折联络服务与初级保健之间的有效护理过渡。进一步的工作应测试将其纳入常规护理环境中的骨折联络服务模式。
