Journal article
Cultivating across "pockets of excellence": challenges to sustaining efforts to improve osteoporosis care
Osteoporosis international, Vol.33(1), pp.139-147
01/2022
DOI: 10.1007/s00198-021-06098-9
PMID: 34414462
Abstract
We conducted in-depth, semi-structured interviews with clinicians involved in bone health care to understand the challenges of implementing and sustaining bone health care interventions. Participants identified individual- and system-level challenges to care delivery, implementation, and sustainment. We discuss opportunities to address challenges through a commitment to relationship- and infrastructure-building support.
Osteoporosis and fracture-related sequalae exact significant individual and societal costs; however, identification and treatment of at-risk patients are troublingly low, especially among men. The purpose of this study was to identify challenges to implementing and sustaining bone health care delivery interventions in the Veterans Health Administration.
We conducted interviews with endocrinologists, pharmacists, primary care physicians, rheumatologists, and orthopedic surgeons involved in bone health care (n = 20). Interviews were audio-recorded and transcribed verbatim. To determine thematic domains, we engaged in an iterative, qualitative content analysis of the transcripts.
Participants reported multiple barriers to delivering bone health care and to sustaining the initiatives designed to address delivery challenges. Challenges of bone health care delivery existed at both the individual level-a lack of patient and clinician awareness and competing clinical demands-and the system level-multiple points of entry to bone health care, a dispersion of patient management, and guideline variability. To address the challenges, participants developed initiatives targeting the identification of at-risk patients, clinician education, increasing communication, and care coordination. Sustaining initiatives, however, was challenged by staff turnover and the inability to achieve and maintain priority status for bone health care.
The multiple, multi-level barriers to bone health care affect both care delivery processes and sustainment of initiatives to improve those processes. Barriers to care delivery, while tempered by intervention, are entangled and persist alongside sustainment challenges. These challenges require relationship- and infrastructure-building support.
Details
- Title: Subtitle
- Cultivating across "pockets of excellence": challenges to sustaining efforts to improve osteoporosis care
- Creators
- Aaron T Seaman - Iowa City VA Health Care SystemMelissa J A Steffen - Iowa City VA Health Care SystemJennifer M Van Tiem - Iowa City VA Health Care SystemShylo Wardyn - Iowa City VA Health Care SystemXiomara Santana - Iowa City VA Health Care SystemKarla L Miller - Veterans Health AdministrationSamantha L Solimeo - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Osteoporosis international, Vol.33(1), pp.139-147
- DOI
- 10.1007/s00198-021-06098-9
- PMID
- 34414462
- ISSN
- 0937-941X
- eISSN
- 1433-2965
- Grant note
- CIN 13-412 / U.S. Department of Veterans Affairs 10707 / U.S. Department of Veterans Affairs CDA 12-272 / U.S. Department of Veterans Affairs
- Language
- English
- Date published
- 01/2022
- Academic Unit
- Center for Social Science Innovation; General Internal Medicine; Community and Behavioral Health; Otolaryngology; Internal Medicine
- Record Identifier
- 9984359692102771
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