Interventions visant à améliorer la détection et le traitement de l’ostéoporose en soins de première ligne

Background: Osteoporosis is a major public health problem given the consequences of fragility fractures. However, the detection and treatment of osteoporosis remain sub-optimal. New interventions aiming at improving the detection and treatment of osteoporosis are therefore necessary. Objectives: The global objective of this research program was to determine which strategies should be adopted for the development of future primary care interventions in osteoporosis. To do so, three different research projects were conducted, which objectives were to: 1) assess the impact of an osteoporosis workshop offered to primary care physicians on osteoporosis-related medical practices (first research project); 2) evaluate the global effectiveness of primary care interventions in osteoporosis (second research project); and 3) explore the perceptions of community pharmacists, directors of public health agencies and Québec’s Department of Health regarding the role of community pharmacists in health promotion and prevention, and more particularly in the management of osteoporosis and the risk of falls (third research project). Methods: First, a cohort study was conducted using the Régie de l’assurance maladie du Québec’s administrative databases (first research project). Afterward, a systematic review with meta-analysis regarding the effectiveness of interventions aiming at improving the detection and treatment of osteoporosis in primary care was performed (second research project). Finally, a cross-sectional study with a qualitative component was conducted with community pharmacists, directors of public health agencies and the chronic disease prevention director of Québec’s Department of Health (third research project). Results: The first research project showed that although the attendance at a primary care physician workshop was associated with higher rates of osteoporosis medical practices, these rates remained greatly sub-optimal. In the second research project, it was observed that multifaceted interventions targeting primary care physicians and their at-risk patients may improve the management of osteoporosis, but improvements are often clinically modest. Finally, the third research project showed that community pharmacists, directors of public health agencies and the chronic disease prevention director of Québec’s Department of Health consider that community pharmacists should play a significant role in health promotion and prevention, and more particularly in the management of osteoporosis and the risk of falls. However, because of many organizational barriers, an important gap exists between pharmacists’ ideal and actual levels of involvement in the provision of these services. Conclusions: Futures primary care interventions to be developed in osteoporosis should be multidisciplinary, include several components and address the barriers to the application of clinical practice guidelines. Targeting community pharmacists and nurse practitioners more intensively may be an interesting avenue for developing future strategies.

Keyphrases: Interventions, Community pharmacists, Detection, Interventions, Osteoporosis, Prevention, Primary care, Primary care physicians