Treatment initiation

Aged 75 and over

I don’t think there’s an option for it to be initiated in Primary Care for us at the moment because even when we send people home on it the GPs don’t always continue it [Participant ID: 017]

It’s not missed because if I missed it the nurses would pick up… the Fracture Liaison Nurses would pick it up or the Pharmacist would, you know there are various checks that they wouldn’t go out without their bone protection. [Participant ID: 005]

GPs get probably 400 or 500 letters a day, do they read everything? Hopefully they do. [Participant ID: 035]

Aged under 75

[We] don’t know how many have treatment initiated [by GPs] [Participant ID: 017]

It’s almost like [GPs] need a package of almost instructions with a tick box… so that yeah it’s straight forward for them. [Participant ID: 037]

I think that there are sort of conflicts in having guidelines that are actually useful in making an individual treatment decision whilst being sufficiently simplistic enough for someone to be able to commit to memory and remember. [Participant ID: 024]

GPs are fantastic, but how can they be experts and know everything… And that’s why I think we have a duty to them and to our patients to inform appropriately. [Participant ID: 042]

Monitoring

We know that compliance is the issue, and we know that less than 50 % are taking them at the year mark. [Participant ID: 010]

By primary care

This has to be owned by Primary Care, I mean this is a long term condition, osteoporosis and fracture prevention, and GPs are responsible for managing long term conditions [Participant ID: 026]

I think in the hospital we have to remember that these are the GP’s patients not our patients… we have to put responsibility onto the GP and onto the patients to make sure that they do take their tablets. It’s a bit buck passing really but that’s how it needs to be [Participant ID: 002]

Well in theory the GPs should be monitoring these patients… But it doesn’t happen. It might happen on the odd GP, but that isn’t happening [Participant ID: 011].

The GPs that liaise with you are probably the GPs that you’re not worried about because they are trying to improve their knowledge; it’s the ones that you never hear about that never call you that think they can manage this condition that they can’t [Participant ID: 020]

By secondary care

The patients didn’t realise [taking the medication] was that important, I don’t think. Whereas if they’re getting a phone call at three months to check they’re going to think, “Well it must be important because they’re phoning me to see if I’m taking the tablet. Oh I’d better carry on taking it. [Participant ID: 010]

It was a waste for them coming in, ten minute appointment, and it was a waste of a clinic slot that could be done for someone that is struggling or not responding or needing treatment. [Participant ID: 042]

Usually [undertaking a ward round in a nursing home] is simpler than the patient coming here and if the patients come here they usually come with an escort who doesn’t have additional information, whereas if we go there the patient has the nurses that have been looking after the patient and we get a lot more information from them that way. [Participant ID: 038]

I would like far more time to be able to follow these patients up more thoroughly [Participant ID: 002]

I just don’t have the resource to [follow-up] [Participant ID: 023]

Six months down the line, the horse has already bolted and they won’t remember what you said beforehand, so I think three months is at least the initial thing [Participant ID: 024]

[6 – 12 weeks is] a nice length of time to revisit all the information you gave them at the diagnosis, and make sure that they’re understanding everything, and that you can go through the lifestyle again… I think any sooner would be too quick, and maybe a bit longer is too long. [Participant ID: 042]

So [monitoring] doesn’t become so unwieldy… identify your patients that you really need to follow up and identify the patients that you may [Participant ID: 028]

It’s more that you need flexibility within the service to be able to account for the differences in individuals. [Participant ID: 024]