Patient-experiences of osteoporosis care through an Integrated, People-Centred Health Services (IPCHS)-framework lens: an international perspective

Abstract

Introduction: Aligning healthcare systems worldwide to meet the challenge of caring for the world’s rapidly growing older population is among the most important goals of the World Health Organization (WHO) Decade of Healthy Ageing (2021-2030). This entails ensuring people have broad access to the most effective diagnostic and prevention strategies, treatments and care for diseases that disproportionately impact the aging, such as osteoporosis. Currently, health systems do not succeed in meeting the needs of osteoporosis patients. Previous studies have demonstrated unmet needs in terms of accessibility, affordability, patient-centredness and comprehensiveness. In order to reorient health care systems towards a more integrated approach supporting these rightful demands, the WHO has developed the framework on Integrated, People-Centred Health Services (IPCHS), encompassing five interdependent strategies and 20 substrategies that support health care delivery integration. Whilst these strategies are often implemented by stakeholders, the patient perspective with regard to these strategies is poorly understood. The study aims to analyse the gaps in osteoporosis care as experienced by patients and relate them to IPCHS-strategies.
 Methods: Individual interviews were performed by two researchers, using a semi-structured interview guide. Interviews were held in English, Dutch, Spanish and French, recorded using screen recording, and transcribed at verbatim. Interviews were first analyzed deductively based on the IPCSH framework, assigning patient responses to one or more substrategies of the five IPCHS strategies. Afterwards, inductive analyses per sub-strategy were performed.
 Results: Thirty-five (33 women, 2 men) patients from 14 countries were interviewed. From the 20 IPCHS substrategies, patients mostly reported difficulties and shortcomings they experienced in relation to “empowering and engaging individuals and families” such as patient education and shared decision making, and “coordinating care for individuals” with an emphasis on multidisciplinary care pathways, respectively. They also inclined a larger focus is needed on preventive services. High out-of-pocket payments were considered an important barrier in accessing services and comprehensive care. Patients advocated for stronger primary care-based services in which more continuity and follow-up is provided by a dedicated physician.
 Conclusion: Improvements in integrated, people-centred osteoporosis care should focus on patient-reported experiences with care.
 Ethical approval: Approval for the study has been provided by the Ethics Committee (EC) of Ghent University Hospital (BC-10951). All participants signed an informed consent form after receiving written and verbal information. This study has been made possible through a value-based partnership between Ghent University and Amgen.