E061 Do proformas used in Fracture Liaison Service appointments reflect national osteoporosis clinical standards? A content analysis
Authors: Abdelmagid Sittana , Bullock Laurna , Paskins Zoe 
Published: April 2023

Abstract

Background/Aims
Fracture Liaison Services (FLSs) identify people aged 50 and older who have had a fragility fracture to target for a bone health assessment, aiming to reduce future fractures. National osteoporosis guidelines outline key standards for service provision. Despite their common goal, the content of FLSs varies across the UK. FLSs, which are typically nurse-led, use proformas (documents used to plan, record and evaluate care using information collected within a clinical consultation) to guide them to meet these clinical standards. This study aimed to identify how much the FLS proformas reflect national osteoporosis guidelines and identify differences across services and gaps for improvement.

Methods
FLS clinicians taking part in the iFraP (Improving uptake of Fracture Prevention drug treatments) study usual care e-survey uploaded their service proformas for review. The content of the proformas were quantitatively analysed against the Royal Osteoporosis Society Clinical Standards for FLSs; the criteria assessed were: Standard 2 (investigations assessing risks of fragility fractures and falls, and possible secondary causes for osteoporosis are offered), Standard 3 (information and support is offered to people/carers) and Standard 4 (interventions are offered to reduce fragility fracture risks). Microsoft Excel was used to record if a criterion within the standards was met (present), partially met (mentioned) or not met (absent) in the proforma. Data was extracted by one reviewer, with a sample of proformas dual extracted to assess consistency. Discrepancies were resolved in discussions with a third reviewer. Elements of the proformas not considered in the standards was also extracted.

Results
A total of 8 proformas were analysed. All 8 proformas met (n = 7) or partially met (n = 1) standard 2 in investigating underlying secondary causes of a fracture, including assessing future fracture risk using FRAX or DXA; and assessing falls risk in over 65s. In standard 4, initiation of drug treatment and falls prevention referrals at the consultation was met in 7/8 proformas.
Within Standard 3; giving information on osteoporosis and fracture risk was either partially met (n = 6) or not met (n = 2). Offering information related to lifestyle interventions was met in 4/8 proformas, and coping with pain and disability associated with a fracture was not assessed in any proformas.
One proforma collected information on psychosocial factors related to loneliness and fuel poverty, not included in the standards.

Conclusion
This content analysis highlighted consistency across FLS proformas in identifying fractures, assessing fracture risk and initiating drug treatment. However, many FLS proformas indicated gaps in information offered to patients, especially in key areas related to pain and disability. Further research is needed to understand how quality of life can be assessed in the consultation to strengthen follow up support pathways (i.e. pain management) to enable patient centred-care for patients living with a fracture.
Disclosure
S. Abdelmagid: None. L. Bullock: None. Z. Paskins: None.