A qualitative evaluation of a fracture liaison service in an academic healthcare system

Osteoporosis is an often underdiagnosed and undertreated disease despite its serious consequences. To bridge this gap, fracture liaison services (FLSs) have been implemented in institutions for patients with fractures. Our institutional FLS provides centralized outreach for patients with new fractures and is supported by embedded clinical pharmacists. It has been demonstrated to improve process outcomes, but there is still room for growth. This qualitative evaluation sought to capture healthcare professionals' perspectives on FLS processes, successes, and barriers, to determine how the service could be further improved.

We conducted 22 semistructured interviews with those who delivered the service and primary care providers (PCPs) who utilized the service. We used thematic analysis and a rapid qualitative approach to identify emerging themes.

We identified 6 overarching themes. Successes included helping to identify patients whose new osteoporosis diagnosis might have been overlooked or gone untreated despite the presence of a new fracture, streamlining the process to make it easier for PCPs to address osteoporosis, and providing education for patients and PCPs. Challenges included programmatic issues such as workflow inconsistencies, systemic delays in obtaining laboratory results and dual-energy X-ray absorptiometry scans, and the inappropriateness of the service for some medically complex patients.

PCPs recognize the value of the FLS program; however, challenges can hinder optimal execution of service components. Opportunities for improvement include more timely communication between the delivery team and PCPs, clearer documentation processes, and further disease state education for both PCPs and patients.