Pharmacist-led osteoporosis review: perceptions of current practice, care gaps and implementation challenges

Adherence to oral bisphosphonates for osteoporosis is poor; the challenges and complexity of follow-up reviews in general practice are implicated as a contributory cause. Clinical pharmacists in general practice are an expanding professional group within the UK NHS workforce and could provide person-centred, medicines optimisation interventions. To explore clinician and patient perceptions towards a pharmacist-led osteoporosis review, including identifying current practice, care gaps and implementation barriers and facilitators. Qualitative interview study with patients, clinical pharmacists, GPs, osteoporosis specialists and service commissioners. Semi-structured interviews were transcribed verbatim and analysed thematically, informed by a Normalisation Process Theory approach. In total, 32 participants were interviewed in 22 one-to-one interviews and 4 small group interviews. Three themes relevant to the design and implementation of a pharmacist-led osteoporosis follow-up review were identified: dissonant views about current provision and needs ; suitability and acceptability of pharmacists to deliver the review and training needs for this; and contextual issues affecting implementation. Our study found that current practice with respect to following-up patients initiated on oral bisphosphonate treatment in primary care is variable. Although pharmacists were highlighted as well placed to conduct osteoporosis reviews, varying views about the need for this were highlighted along with a number of contextual barriers, including lack of financial and policy drivers in primary care, workload challenges, varying pharmacist skills and autonomy and lack of coordination across the health system.