Osteoporosis group consultations are as effective as usual care: Results from a non‐inferiority randomized trial

Abstract

AbstractBackgroundGroup consultations led by doctors or nurses are widely used in diabetes and hypertension and are promising in inflammatory arthritis.ObjectiveTo show effectiveness in other musculoskeletal conditions with other professionals.HypothesisGroup consultations as effective as one‐to‐one consultations for treating patients at risk of osteoporotic fracture, defined by 10‐year fracture risk.DesignRandomized controlled non‐inferiority trial, with parallel groups randomized by patientSettingThree primary care practices, Northumberland, United KingdomPatientsA total of 158 patients consenting to the study from 1052 patients ≥50 years invited from the highest 10‐year fracture risk group.InterventionsPharmacist‐led clinic appointment either in one of four 90‐min group consultations (n = 75) or comparator usual care consultation (n = 83).MeasurementsPrimary outcome measure – mean possession ratio of bisphosphonates over 12 months (doses requested/all possible doses). Secondary outcomes included treatment persistence.ResultsTen‐year fracture risk for major osteoporotic/hip fracture was 26%/14% for group and 23%/10% for usual care, respectively. Mean possession ratio was 0.62 (interquartile range [IQR] = 0.23‐0.92) for group and 0.54 (IQR = 0.15‐0.92) for usual care (confirmed as non‐inferior).LimitationsSingle pharmacist delivered the intervention/comparator, although piloting showed nurses or doctors equally competent; small number of practices.ConclusionsOutcomes for group consultations were non‐inferior to those for usual care in osteoporosis. Mean pharmacist contact time per patient was lower for group consultations, so this model was efficient and saved costs. Clinicians from different disciplines with facilitation skills can be trained easily and improve routine service delivery for chronic conditions through group consultations: a promising response to escalating demand for healthcare.