Fracture liaison services (FLS) have been shown to prevent efficiently subsequent fragility fractures (FF). However, very few studies have examined their implementation in depth. The purpose of this research was to identify factors influencing the implementation of a FLS at three sites in Quebec, Canada. From 2013 to 2015, individual and group interviews focused on experiences of FLS stakeholders, including implementation committee members, coordinators, and orthopaedic surgeons and their teams. Emerging key implementation factors were triangulated with the FLS patients’ clinico-administrative data. The Consolidated Framework for Implementation Research guided the analysis of perceived factors influencing four intervention outputs: investigation of FF risk (using the FRAX score), communication with the participant primary care provider, initiation of anti-osteoporosis medications (when relevant), and referral to organized fall prevention activities (either governmental or community based). Among the 454 FLS patients recruited to the intervention group, 83% were investigated for FF risk, communication with the primary care provider was established for 98% of the participants, 54% initiated medication, and 35% were referred to organized fall prevention activities. Challenges related to restricted rights to prescribe medication and access to organized fall prevention activities were reported. FLS coordinator characteristics to overcome those challenges included self-efficacy beliefs, knowledge of community resources, and professional background. This study highlighted the importance of enabling access to services for subsequent FF prevention, consolidating the coordinator’s role to facilitate a more integrated intervention, and involving local leaders to promote the successful implementation of the FLS.
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The authors would like to thank all study participants, Chantal Morin for her collaboration to data coding, and Meg Sears for editorial revisions.
This work was supported by the Canadian Institutes of Health Research [Grant number 201111PHE-267395-PHE-CFDA-01003-001] in partnership with the Ministère de la Santé et des Services sociaux, Merck Sharp & Dohme Corp., Novartis, Amgen and the Centre de santé et de services sociaux—Institut universitaire de gériatrie de Sherbrooke (Centre intégré universitaire de santé et des services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke). The funding sources had no involvement in the study design, the conduct of the research or the preparation or the submission of the article.
Conflict of interest
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcomes. Dr Boire would like to declare that, in the past 2 years, he has received funding from Merck Canada and from Amgen Canada for other research projects, as well as a remuneration from Merck Canada for a conference.
The study protocol was approved by the Ethics Committee of the Centre Hospitalier Universitaire de Sherbrooke on January 8th, 2013, and by relevant local ethics committees (Comité d’éthique de la recherche et de l’évaluation des technologies de la santé de l’Hôpital du Sacré-Coeur de Montréal, CÉR du CSSS du Sud de Lanaudière, Comité d’éthique de la recherche du CSSS-IUGS, and Comité d’éthique de la recherche du CIUSSS du Centre-Sud-de-l’Île-de-Montréal; Comité d’éthique de la recherche de l’Hôpital Maisonneuve-Rosemont, May 8th, 2013; CÉR du CSSS du Nord de Lanaudière and CÉR du CSSS du Roché Percé, October 31st, 2013; and Comité d’éthique de la recherche sur les sujets humains du Centre hospitalier universitaire de Montréal, November 20th, 2013). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. For confidentiality reasons, each study site has been represented by a number.
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Luc, M., Corriveau, H., Boire, G. et al. Implementing a fracture follow-up liaison service: perspective of key stakeholders. Rheumatol Int 40, 607–614 (2020). https://doi.org/10.1007/s00296-019-04413-6
- Fracture liaison service
- Implementation science
- Qualitative method
- Program evaluation