Keele Research Repository

Background People with inflammatory rheumatological conditions (IRCs) are at increased risk of common comorbidities including osteoporosis. Aim To explore the barriers to, and facilitators of, implementing nurse-delivered fracture risk assessments in primary care, in the context of multi-morbidity reviews for people with IRCs. Design and Setting A multi-method qualitative study in primary care. Methods As part of a process evaluation in a pilot trial, semi-structured interviews were conducted with 20 patients, 2 nurses and 3 General Practitioners (GPs) and 24 consultations were audio-recorded and transcribed. A framework analysis was conducted using the Theoretical Domains Framework (TDF). Results Nurses reported positive views about the value of FRAX® assessments and confidence in delivering them. Barriers to implementation, as identified by TDF, particularly related to the domains of knowledge, skills, professional roles and environmental context. GPs reported difficulty keeping up to date with osteoporosis guidelines and voiced differing opinions about whether fracture risk assessment was the role of primary or secondary care. Lack of integration of FRAX® into IT systems was a barrier to use. GPs and nurses had differing views about the nurse role in communicating risk and acting on FRAX® findings: explanations of the FRAX® result and action needed were limited. Patients reported limited understanding of FRAX® outcomes. Conclusion The findings suggest that, with appropriate training including risk communication, practice nurses are likely to be confident to play a key role in conducting fracture risk assessments, but further work is needed to address the barriers identified.