Implementing pharmacist-led home medicines reviews within fracture liaison services for better post-fracture care: a qualitative study of patient and practitioner experience.

UNLABELLED: Home medicines reviews present a novel intervention supporting continuity of care between fracture liaison services and primary care. Home medicines review pharmacists deliver multifaceted, collaborative interventions that can bridge gaps in care, promote patient empowerment, facilitate a GP-patient discussion about bone health, and improve coordination of care.

PURPOSE: Medication review has potential to reduce the risk of falls and fractures and improve transition of care from a specialist fracture liaison service to primary care. This study was designed to examine and evaluate the implementation of a home medicines review into fracture liaison services in Australia. Study objectives were to (1) explore how home medicines reviews might facilitate the healthcare transition from fracture liaison service to primary care and (2) identify factors required to achieve this.

METHODS: This was a qualitative descriptive study nested within a randomised trial (reported elsewhere). Semi-structured interviews were conducted with patients and healthcare practitioners responsible for providing osteoporosis services. Formative and early-stage data collection occurred September 2022 to January 2024. Thematic analysis was employed inductively (data-driven) and directed content analysis was applied deductively (theory-driven) using the consolidated framework for implementation research (CFIR) domains to frame factors affecting home medicines review implementation.

RESULTS: Fifty-six interviews were performed: 25 with pharmacists, 14 with fracture liaison service clinicians, seven with GPs, and ten with patients. Participants perceived home medicines review pharmacists to be uniquely positioned to favourably influence the transition to primary care by (1) identifying gaps in care, (2) promoting patient empowerment, (3) facilitating a GP-patient discussion about bone health, and (4) improving coordination of care. Factors affecting home medicines review implementation related to CFIR domains of the individuals (patient and GP engagement and willingness to accept advice, patient preparedness, GP confidence deprescribing), the innovation (hospital endorsement of home medicines review reports, perception of intervention value, embedded administrative assistants, pharmacist expertise), the inner setting (role clarity, multidisciplinary teamwork culture, and patient-centred focus, scheduling practices, and communication systems), and outer setting (access to telehealth services, a network of mobile pharmacists, and appropriate remuneration systems).

CONCLUSION: Home medicines review pharmacists delivering multifaceted, collaborative, and patient-centred interventions can support effective transition of care between fracture liaison services and primary care. Further work should test their integration into fracture liaison service models within routine care environments.