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dc.contributor.authorHawarden, Ashley W
dc.contributor.authorPaskins, Zoe
dc.contributor.authorDesilva, Erandie Ediriweera
dc.contributor.authorHerron, Daniel
dc.contributor.authorMachin, Anabelle
dc.contributor.authorJinks, Clare
dc.contributor.authorHider, Samantha
dc.contributor.authorChew-Graham, Carolyn
dc.date.accessioned2020-12-04T15:56:17Z
dc.date.available2020-12-04T15:56:17Z
dc.date.issued2020-04-20
dc.identifier.citationHawarden, A.W., Paskins, Z., Desilva, E.E., Herron, D., Machin, A., Jinks, C., Hider, S. and Chew-Graham, C., (2020). 'P193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary care'. Rheumatology, 59(Supplement_2), pp. 111-188.en_US
dc.identifier.issn1462-0324
dc.identifier.doi10.1093/rheumatology/keaa111.188
dc.identifier.urihttp://hdl.handle.net/10545/625447
dc.description.abstractThe INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community) pilot trial aimed to evaluate the feasibility and acceptability of a nurse-delivered review in primary care for people with inflammatory rheumatological conditions (IRCs), to identify and manage common comorbidities including anxiety and depression, cardiovascular and fracture risk. We report analysis of data focusing on the fracture risk assessment component of the review. Ethical approvals obtained. Semi-structured interviews were conducted to explore experiences of participating in INCLUDE, with 20 patients, the two nurses delivering the intervention and three General Practitioners (GPs) within participating practices. 24 consenting patients had their INCLUDE review recorded for fidelity checking. Selected extracts were played within some interviews to stimulate discussion (tape-assisted recall). Extracts from recorded consultations relating to fracture risk assessment were transcribed and coded. Interviews were digitally recorded, with consent, transcribed and anonymised. Thematic analysis of the interview data was followed by mapping to the Theoretical Domains Framework (TDF). Findings mapped to 10/14 TDF domains relating to knowledge, skills, social/professional role and identity, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, intentions, memory attention and decision processes and environmental context/resources. GPs and nurses identified a lack of knowledge and skills in relation to the identification and management of osteoporosis, due to lack of exposure and repeated changes in clinical guidance. GPs reported differing opinions about whether osteoporosis screening was the role of primary or secondary care. GPs and nurses had differing views about the limits of the nurse role in communicating risk. The INCLUDE nurses reported confidence (self-efficacy) in undertaking FRAX assessments. Nurses valued the opportunity to learn new skills and believed that they were improving patient care. They described practical barriers using FRAX including the difficulty navigating between different IT systems. Nurses described uncertainty over when to refer to the GP. Fidelity checks of recorded reviews, showed that FRAX was appropriately calculated for 22/24 patients; whilst INCLUDE nurses introduced the reason for calculating fracture risk, explanations of the meaning of risk were limited, and patients’ understanding was not always checked and queries not responded to; patient interview findings confirmed patients had limited understanding of the meaning of FRAX. Life-style advice related to bone health was given in few consultations. Screening for fracture risk in people with IRCs in a review consultation is acceptable and feasible, although explanations of the meaning of risk assessment could be improved. Integration of a fracture risk assessment tool within GP software would facilitate risk calculation. More work is needed to understand barriers to risk assessment, including clarity over roles and professional boundaries, and develop management pathways to optimise management of fracture risk in people with IRCs.en_US
dc.description.sponsorshipN/Aen_US
dc.language.isoenen_US
dc.publisherOxford University Press (OUP)en_US
dc.relation.urlhttps://academic.oup.com/rheumatology/article/59/Supplement_2/keaa111.188/5822360en_US
dc.rights.urihttps://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model
dc.subjectPharmacology (medical)en_US
dc.subjectRheumatologyen_US
dc.titleP193 Experiences of delivering a nurse-led fracture risk assessment for patients with inflammatory rheumatological conditions in primary careen_US
dc.typeArticleen_US
dc.identifier.eissn1462-0332
dc.contributor.departmentPrimary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Stoke on Trenten_US
dc.contributor.departmentHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trenten_US
dc.contributor.departmentUniversity of Derbyen_US
dc.identifier.journalRheumatologyen_US
dc.source.journaltitleRheumatology
dc.source.volume59
dc.source.issueSupplement_2
dcterms.dateAccepted2020
dc.author.detailN/Aen_US


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