The Michael Mason prize: development and feasibility testing of a complex intervention to improve adherence to fracture prevention medicine

Objectives Only 12% of people recommended fracture prevention medicines remain on treatment 1 year post fracture. The ‘improving uptake of Fracture Prevention treatments’ (iFraP) intervention aims to improve shared decision-making (SDM) about, and uptake of, osteoporosis medicines in Fracture Liaison Services (FLS). This paper details development and feasibility.

Methods Intervention development was underpinned by (i) theories of SDM, medicines adherence and behaviour change; (ii) integrated findings from seven development studies; and (iii) extensive patient and clinician contribution, identifying key ‘needs’ to address and the intervention’s content, functionality and scope. Feasibility testing was conducted at one English FLS. Intervention consultations were observed and audio recorded. Interviews completed with FLS clinicians and patients explored perceived acceptability and feasibility.

Results Intervention development identified patient and clinician unmet needs for personalized and evidence-based information about osteoporosis, its consequences, and its treatment within and after FLS consultations, to facilitate clinical and SDM about medicines. The prototype intervention (osteoporosis decision support tool, clinician skills training and information resources) was designed to meet identified needs and overcome barriers to use. Clinicians delivered the prototype iFraP intervention in 10 consultations with consenting patients. Findings demonstrated that the intervention was acceptable and feasible to deliver, with potential to improve patient outcomes. The intervention was refined to support implementation.

Conclusion The multi-facilitated approach to intervention development and testing ensured that the iFraP intervention appears acceptable and feasible for use in UK FLS to support SDM about osteoporosis medicines. The iFraP trial will evaluate implementation, and cost and clinical effectiveness.