Healthcare Processes Research Articles

Concept analysis of patient journey disruptions: the obstacle of integrated care

PurposeThis article aims to clarify the concepts used to understand, analyze and improve a patient’s progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is implemented, it turns into a patient journey of what is done, what happens to a patient’s medical condition and what is experienced and felt. We introduce “patient journey disruption” (PJD) as a concept describing the events that need to be prevented from happening to accomplish integrated, coordinated and seamless care.Design/methodology/approachThe method used in this paper is concept analysis. First, an expert steering group worked to refine the concept of PJDs; second, an analysis of similar concepts from related fields was done to root the concept into existing theories, and third, semi-structured interviews with professionals and patients were done to test the concept of PJDs in the home care context.FindingsPJDs are agency-based harmful events in the execution of the care pathway that deviate the patient journey from what can be reasonably expected. PJDs are management failures, which is why they should be studied by healthcare operations management (HOM) and service science scholars with the intention to find ways to prevent them from happening.Research limitations/implicationsThis study has limitations, including presenting conceptual ideas and preliminary results that are only indicative.Practical implicationsWe believe that the introduction of the concept of PJDs into the literature provides a new, systematic way of approaching the different shortcomings in our healthcare production systems. Moreover, by systematically identifying different PJDs, interventions can be designed and targeted more appropriately.Originality/valueManagerial challenges regarding healthcare processes have been studied but have not been well defined. The concept of PJDs is an original, well-thought-out definition.

Patients' Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis.

To identify, appraise, and synthesize qualitative research evidence exploring patients' needs regarding work-focused healthcare. A systematic review was conducted in accordance with the PRISMA statement guidelines to identify studies reporting patients' needs regarding work-focused healthcare. Four databases (MEDLINE, Embase, PsychInfo and Web of Science) were systematically searched from January 2000 until May 2023 and screened in duplicate by pairs of two reviewers. Inclusion criteria were qualitative data collection method, and patients' perspectives regarding healthcare focusing on work when experiencing work-related problems due to chronic medical conditions. Data extraction and synthesis was executed by means of an inductive thematic analysis approach. The quality of the included studies was assessed using the CASP Qualitative Study checklist. Confidence in the review findings was assessed through the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. Out of 23,677 records, 97 qualitative studies were included. Needs regarding four main themes were identified: (1) Substantive guidance, which comprises the specific content of work-focused healthcare; (2) Clear and continuous process, which comprises clarification and optimization of the work-focused healthcare process; (3) Supportive attitude and behavior, which comprises a positive and supportive attitude and behavior from professionals towards the patients; and (4) Tailored approach, which comprises the delivery of tailored care to the individuals' needs. 17 subthemes were identified. The broader insight in patients' needs in work-focused healthcare can help (occupational) healthcare professionals adopt a more patient-centred approach in practice.

School Nurses' Perceived Role and Capacity to Support School Behavioral Health Programs in DC Public and Public Charter Schools.

School nurses (SNs) practicing in DC public and public charter schools were surveyed to assess their perceived role and self-reported preparation to provide behavioral health prevention, early identification, and treatment services in schools. A total of 154 SNs completed a questionnaire about their role in the delivery of behavioral health services and supports. SNs reported they are primarily involved in the identification and referral of students to other school behavioral health professionals. Respondents also reported a lack of training in behavioral health and a desire for more information on related programs and services. This study offers recommendations for educating future SNs and highlights how the DC School Health Services Program utilized study findings to build capacity for SNs employed in practice. This study can help tailor educational opportunities for SNs to maximize their role in school behavioral healthcare process flows and ultimately improve outcomes for students and families.

Analysis of skin health management through telemedicine and mobile health in dermatology in the post-COVID era

Mobile health has made significant strides in the field of tele-dermatology (TD) following the developments post the COVID-19 pandemic. The application of telemedicine and mobile health to dermatology holds the potential to enhance the quality of healthcare for citizens and streamline workflows in the healthcare domain, hence this subject is of great importance. This research encompasses the last three years. A comprehensive overview examining the opportunities, perspectives, and encountered challenges regarding the integration of TD with mHealth has been provided. The narrative review methodology is based on (I) conducting research via PubMed and Scopus, and (II) conducting compliance assessment using the proposed parameters. The outcome of the research indicates rapid progress in the integration of TD with mobile health during the COVID-19 pandemic. This integration has facilitated the monitoring of dermatological issues and allowed for remote specialist visits, thereby reducing face-to-face interactions. Artificial intelligence and mobile applications have empowered citizens to take a more active role in their own healthcare, which is distinct from other imaging areas where information exchange is limited only to professionals. Opportunities that TD can offer in the field of mobile health include enhancing service quality, increasing the efficiency of healthcare processes, reducing costs, and providing more accessible care. This is applicable not only to conditions like acne, vitiligo, psoriasis, and skin cancers but also to other conditions. Integration with artificial intelligence and augmented reality (AR), along with the use of wearable sensors, are expected as future developments. However, the integration of TD with mobile health brings along issues and challenges related to regulation, ethics, cybersecurity, data privacy, and device management. These issues, along with the involvement of citizens in the process, should be addressed by scientists and policymakers.

Measuring the relationship between reciprocity behaviour and technology readiness of nursing staff working in residential care and community nursing: A cross-sectional study.

The aim of this study is to measure how collaborative factors are associated with the technology readiness of nursing staff working in residential care and community nursing. The Reciprocity Instrument and Technology Readiness Index 2.0 were applied to measure this association. A cross-sectional survey was conducted between October 2020 and January 2021. The Technology Readiness Index 2.0 was translated into Dutch, administered together with the Reciprocity Instrument and linguistically validated. And 1660 Registered Nurses and Nursing Assistants received an invitation to the online survey. Descriptive statistics and regression analyses were used to analyse the data. A total of 475 nursing staff responded, a response rate of 28.6%. The following factors have a statistically significant association with technology readiness: age, education level, years of working experience, type of organization, reciprocity behaviour and conditions of reciprocity behaviour: digital communication usage to reach one another, multilayeredness and future perspective. This study shows that reciprocity behaviour is positively associated with technology readiness. The influencing factor reciprocity remains intact after the correction of the other factors that were measured. This confirms the relevance of collaborative factors that influence the technology adoption process of nursing staff working in residential care and community nursing. This study offers insights into how collaboration based on reciprocity behaviour positively impacts the technology readiness of nursing staff engaged in residential care and community nursing and could be used in the education of nursing staff and healthcare teams. Being aware of the impact that collaborative factors have on the adoption process of ICT among nursing staff could be used to support the desired preparatory activities as part of ICT implementation for healthcare managers, innovators, and nursing work groups charged with implementing technology in the healthcare process. The study has adhered to STROBE guidelines. No Patient or Public Contribution.

Perspectives of South Asian Youth in the United States about Gender Norms and Healthcare Decision Making

Abstract The aim of this study was to explore the voices of South Asian youth in the United States about gender norms and healthcare decision making. Ten focus group discussions were held with 36 students of South Asian origin at a university on the West Coast of the United States. Thematic analysis was performed on the focus group data. Three main themes emerged from the data: (1) intersectionality of gender with other factors that affect healthcare decision making, (2) impact of gender on health, and (3) coping strategies. Participants reported preferential treatment for boys versus girls, vesting decision-making control among males, worse health among females, and coping strategies. A few responses indicated that power differentials in some families were shifting to a more egalitarian balance between males and females. Aspects such as age, employment, and language barriers intersected with gender to create a complex web of influence on healthcare decision making. The study has implications for social workers to offer culturally responsive support to South Asian youth in the United States, paying attention to the intersectionalities when working with them. Further research is needed to explore the influence of gender on healthcare decision-making processes of South Asian youth in the United States.

Enhancing Patient Outcomes Through Integrated Education and Navigation Programs at the Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University.

Breast cancer remains a significant global health challenge, particularly in low- and middle-income countries where disparities in healthcare exacerbate the disease burden. The Breast Cancer Comprehensive Center at the National Cancer Institute, Cairo University, has implemented integrated patient navigation and education programs aimed at enhancing patient outcomes and healthcare quality.This study evaluated the effectiveness of these programs involving 2202 participants over 12 months. The methodology included systematic data collection, material preparation, and the application of tailored educational strategies to facilitate the patient's journey from diagnosis to treatment. The study utilized three-phased patient navigation assistance to provide comprehensive support.The programs significantly improved patient satisfaction, with over 90% of participants reporting high levels of contentment with the services received. Key improvements included enhanced understanding of breast cancer (including risk factors, symptoms, importance of seeking early care, and treatment options), reduction in patient anxiety, improved treatment adherence, and streamlined diagnostic and treatment processes. Notably, the use of audio-visual educational tools effectively bridged the literacy gap among patients.The integration of patient navigation and education systems at BCCC-NCI has proven to be a highly effective model for improving breast cancer care. This model not only enhances patient understanding and treatment compliance but also facilitates a more efficient healthcare process. The study underscores the potential for replicating this approach in similar healthcare settings globally, suggesting that such integrations can significantly improve cancer care outcomes.

Greening Infection Prevention and Control: Multifaceted Approaches to a Sustainable Future

Abstract Infection prevention and control, or IP&C, is a critical stakeholder in advancing environmental sustainability in healthcare. IP&C activities seek to ensure safety of processes in health care from an infection perspective, but how these are performed can drive substantial waste and pollution. There are certain IP&C measures that can, without compromising safety or efficiency, be adapted to more environmentally friendly practices and have a high impact benefit to sustainability without affecting patient outcomes. Moreover, IP&C practice stands to be significantly altered by climate change and pollution. Here, we describe the complex interdependence between sustainability, climate change, and IP&C, and opportunities for IP&C to be at the leading edge of optimizing healthcare’s environmental footprint.

Nanostructured transition metal dichalcogenides-based colorimetric sensors: Synthesis, characterization, and emerging applications.

Nanostructured transition metal dichalcogenides (TMDCs) have garnered significant attention as prospective materials for the development of highly sensitive and versatile colorimetric sensors. This work explores the synthesis, characterization, and emerging applications of TMDC-based sensors, focusing on their unique structural aspects and inherent properties. The synthesis methods involve tailored fabrication techniques, such as chemical vapor deposition and hydrothermal processes, aimed at producing well-defined nanostructures that enhance sensor performance. Characterization techniques, including microscopy, spectroscopy, and surface analysis, are employed to elucidate the structural and chemical features of the nanostructured TMDCs. These analyses provide insights into the correlation between the material's morphology and its sensing capabilities. The colorimetric sensing mechanism relies on the modulation of optical properties in response to specific analytes, enabling rapid and visual detection. The emerging applications of TMDC-based colorimetric sensors span diverse fields, including environmental monitoring, healthcare, and industrial processes. The sensors exhibit high sensitivity, selectivity, and real-time response, making them ideal candidates for detecting various target analytes. Furthermore, their integration with complementary technologies such as microfluidics, can facilitate the development of on-site and point-of-care applications. This work highlights the interdisciplinary significance of nanostructured TMDC-based colorimetric sensors and underscores their potential contributions to addressing contemporary challenges in sensing technology.

Evaluation of the Ghanaian Healthcare Environment and Patient Safety context using the SEIPS model of Work System

Objective: This paper aimed to evaluate hazards contributing to patient safety incidents within Ghana’s healthcare system using a human factors engineering model to trace risks across interacting domains. Methods: The Systems Engineering Initiative for Patient Safety (SEIPS) model framed analysis of challenges within the dimensions of healthcare Personnel, Tasks, Tools/Technology, Environment, Organization and Processes. Over 25 studies provided multi-dimensional empirical evidence, with insights synthesized across domains to depict risk pathways enabling patient harm events. Conclusions: The analysis reveals a severely overburdened and constrained healthcare ecosystem unable to reliably deliver safe care processes – with risks stemming from financing limitations, infrastructure deficits, equipment failures, health worker shortages and skills gaps, supply variability, leadership prioritization, and information systems. Solutions require coordinated commitment across these interdependent aspects. Recommendations: Six priority actions are proposed spanning governance, culture, staffing, health IT, quality programs and financing – grounded in concrete evidence-based initiatives but connected through systems thinking. Significance: This systems analysis substantially advances understanding of patient safety threats in Ghana to motivate action. The model approach further demonstrates application of human factors engineering methods to diagnose healthcare quality challenges in limited-resource settings.

A Rapid Review of How Model‐based Systems Engineering is Used in Healthcare Systems

AbstractThis study presents the results from rapid review of how model‐based systems engineering (MBSE) is utilized in healthcare systems (HSs). We conduct a review of the last twelve years and find that MBSE adoption in HSs is accelerating, with use of various MBSE languages and tools, as well as their integration with other simulation and modeling techniques. We find that similar to engineered systems, the most common MBSE language is systems modeling language (SysML), followed by unified modeling language (UML) and others. Additionally, we observe that MBSE methods are frequently used in conjunction with other analytical techniques, such as simulation and co‐simulations, to analyze and enhance various HS operations, or to assist with making tradeoffs between HS attributes such as quality and cost. Moreover, we provide a non‐exhaustive classification of current research based on two dimensions: healthcare applications and MBSE use cases. Notably, MBSE is being implemented generally with patient‐centric objectives in various HS domains, including IoT‐enabled smart healthcare, clinical medicine, medical device development, healthcare process enhancement, and healthcare facilities management. While the primary MBSE use case involves modeling different aspects of healthcare operations, there is a significant number of studies that pursue requirements engineering, systems analysis, integration, verification and validation, as well as risk analysis and management. Furthermore, we identify two promising research gaps. First, there is a need for the integration of MBSE with state‐of‐the‐art data‐driven analytical methodologies such as hybrid simulation and artificial intelligence techniques. Second, HSs could greatly benefit from representing the cognitive functions and processes of human decision‐makers in the loop, such as healthcare providers (e.g., doctors and nurses), who are instrumental in sustaining the HS performance and functionality. We contend that MBSE and other SE methods and techniques could improve HSs design, operations, and management; while fostering resilience and long‐term sustainability.

Development of an instrument to measure the competencies of health professionals in the process of evidence‐based healthcare: A Delphi study

AbstractAimsTo identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence‐based healthcare.DesignA two‐round Delphi survey was carried out from April to June 2023.MethodsConsensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence‐Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.ResultsSixteen national and three international experts were involved in the first‐round Delphi survey and 17 experts participated in the second‐round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence‐generation, evidence‐synthesis, evidence‐transfer and evidence‐implementation. In round‐one, the instrument was revised from 77 to 61 items. In round‐two, the instrument was further revised to have 57 items under the four dimensions in the final version.ConclusionThe Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.Implications for the Profession and/or Patient CareSystematic assessment of nurses and other health professionals' competencies in different phases of evidence‐based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence‐based practice and better care process and outcomes.ImpactThis study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.Reporting MethodThis study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.Patient and Public ContributionNo patient or public contribution.

A Systemic Review on the Adoption of Service Design Practices to Improve the Quality of User Experience and Organization in the Healthcare Environment

Healthcare services and spaces are recognized as complex ecosystems where different user categories interact daily facing often urgent and difficult situations that challenge the established organizational and procedural models. The increasingly evolving needs and conditions influencing the processes affect the capacity to quickly adapt the available operational models as well as spaces to provide a timely and efficient response. This calls for new approaches and methods to enable the managing staff to overcome the conventional silos-based structure and integrate new methods and tools to facilitate interdisciplinary analysis and synergies. Some frontrunning healthcare structures started to adopt Service Design practices, which are largely grounded in the Design Thinking approach, to reshape the conventional models for improving the quality of user experience with remarkable expected impacts on social, economic, and environmental sustainability in the mid-long run. Following the rigorous investigation structure of Systemic Review, the paper explores the adoption of Service Design practices in frontrunner experiences focusing on organizational aspects to draft a reference framework, including successful factors, barriers, and viable pathways, which are currently missing. The main scope of the paper is accordingly to address the detected gaps in clarifying methods tools and goals of Service Design-oriented practices for improving healthcare processes and user experience quality. The main reported findings highlight the importance of introducing Co-Design and participative practices to integrate specialistic perspectives and organizational aspects as well as to engage all the key players at different levels.

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Enhancing healthcare process analysis through object-centric process mining: Transforming OMOP common data models into object-centric event logs

Objectives:This study aims to enhance the analysis of healthcare processes by introducing Object-Centric Process Mining (OCPM). By offering a holistic perspective that accounts for the interactions among various objects, OCPM transcends the constraints of conventional patient-centric process mining approaches, ensuring a more detailed and inclusive understanding of healthcare dynamics. Methods:We develop a novel method to transform the Observational Medical Outcomes Partnership Common Data Models (OMOP CDM) into Object-Centric Event Logs (OCELs). First, an OMOP CDM4PM is created from the standard OMOP CDM, focusing on data relevant to generating OCEL and addressing healthcare data’s heterogeneity and standardization challenges. Second, this subset is transformed into OCEL based on specified healthcare criteria, including identifying various object types, clinical activities, and their relationships. The methodology is tested on the MIMIC-IV database to evaluate its effectiveness and utility. Results:Our proposed method effectively produces OCELs when applied to the MIMIC-IV dataset, allowing for the implementation of OCPM in the healthcare industry. We rigorously evaluate the comprehensiveness and level of abstraction to validate our approach’s effectiveness. Additionally, we create diverse object-centric process models intricately designed to navigate the complexities inherent in healthcare processes. Conclusion:Our approach introduces a novel perspective by integrating multiple viewpoints simultaneously. To the best of our knowledge, this is the inaugural application of OCPM within the healthcare sector, marking a significant advancement in the field.

Psychometric characteristics of a questionnaire to assess perceived disability in people with epilepsy

It has been determined that quality of life in epilepsy is closely related to the perceived disability experienced by individuals with the diagnosis. However, this measure is seldom considered in healthcare processes. The objective of the present study is to establish the psychometric properties of the Perceived Disability Questionnaire in individuals diagnosed with epilepsy within a Latin American context. A cross-sectional, analytical study was conducted involving 325 participants, aged 12 years and older (M 40.42 years), individuals diagnosed with epilepsy in Colombia. The main psychometric properties of the instrument were explored to account for its factorial validity and reliability. The Perceived Disability Questionnaire exhibits high reliability (α = 0.878) and the three subscales comprising the final version of the questionnaire (Dissatisfaction, Pessimism, and Self-Disdain) explain 45.393 % of the total variance in relation to beliefs of disability associated with the diagnosis of epilepsy; the questionnaire significantly correlates with the Quality of Life in Epilepsy Inventory (QOLIE-10). Adequate psychometric properties of the instrument are found, which allows for its proposal as a tool in epilepsy care processes within the Colombian context.

Digitalizing Access to Care: How Self-Check-In Kiosks Shape Access to Care and Efficiency of Hospital Services

Responding to labor shortages and rising healthcare expenses, hospitals increasingly turn to self-check-in kiosks to streamline service delivery and improve patients’ experiences. The purpose of this study was to reflect on the implementation of these self-check-in kiosks in a Dutch university hospital, particularly in relation to access to care for more vulnerable patients and intended efficiency goals. We followed a technology-in-practice approach to better understand how new technologies shape care practices in relation to in/exclusion and carried out an ethnographic action study involving desk research, participatory observations, semi-structured interviews, and reflection sessions with developers and hospital staff. Data were analyzed through ethnographic content analysis. Our results show that although self-check-in kiosks work well for some patients, many people experience practical and psychosocial difficulties, especially those who go through a complex care pathway, are low-literate, experience a distance the online world, or have sensory, motor, or cognitive impairments. Kiosks are not yet attuned to these patients and typically leave little flexibility and room for negotiation and personal support in what is, for many, a foreign environment. Therefore, patients frequently seek confirmation and assistance from already downsized or busy staff. In conclusion, we find that digitalization under the banner of efficiency within a healthcare system already under pressure carries risks, as it can unintentionally generate extra (invisible) work for patients and care professionals and threaten access to and quality of care for patients most in need. A more concentrated effort on refining the digitalization of healthcare processes using an inclusive-technology-in-practice approach has the potential to contribute to fairer and more efficient care for all patients.

Unraveling elements of value-based pricing from a pharmaceutical industry's perspective: a scoping review.

Health authorities use value-based pricing models to determine the value of innovative drugs and to establish a price. Pharmaceutical companies prefer value-based pricing over cost-based pricing. It is ambiguous whether value-based pricing has the same meaning to these stakeholders. We aimed to identify the elements that attribute to value-based pricing of innovative drugs from a pharmaceutical industry's perspective and as possible starting point for (value-based) contracting of drugs. We performed a scoping review of publications available in scientific databases with terms such as 'value-based pricing', 'pharmacoeconomics', 'drug cost', 'innovative drug' and 'drug therapy'. We included 31 publications, covering value elements of innovative drugs from a pharmaceutical industry's perspective. Overall, all found elements of value-based pricing were congruent with the elements of value-based pricing from a health authority's perspective. However, the emphasis placed on the elements differed. The most frequently mentioned elements in our review were economic considerations and cost aspects. Least mentioned were elements regarding cost-effectiveness, disease characteristics and patient characteristics. Although all elements in the drug value framework were present which indicate congruity, there seems controversy on the importance of cost-effectiveness as an element of value. Consequently, establishing a coherent and to all stakeholders' acceptable framework to value and price innovative drugs seems complicated. Mutual understanding can be found in the value elements societal considerations and healthcare process benefits. Our results supported the importance of economic and cost aspects regarding determination of prices of innovative drugs. Further research is required to quantify the weights of all relevant elements in the drug value framework, observe their possible interlinkages, and to weigh them over time.

Analyzing Healthcare Processes with Incremental Process Discovery: Practical Insights from a Real-World Application

Most process mining techniques are primarily automated, meaning that process analysts input information and receive output. As a result, process mining techniques function like black boxes with limited interaction options for analysts, such as simple sliders for filtering infrequent behavior. Recent research tries to break these black boxes by allowing process analysts to provide domain knowledge and guidance to process mining techniques, i.e., hybrid intelligence. Especially, in process discovery—a critical type of process mining—interactive approaches emerged. However, little research has investigated the practical application of such interactive approaches. This paper presents a case study focusing on using incremental and interactive process discovery techniques in the healthcare domain. Though healthcare presents unique challenges, such as high process execution variability and poor data quality, our case study demonstrates that an interactive process mining approach can effectively address these challenges.Graphical

Expert opinion on the management of patients with osteoporosis with anabolic drugs in Italy.

Fragility fractures (FF) resulting from osteoporosis pose a significant public health challenge in Italy, with considerable socio-health and economic implications. Despite the availability of safe and effective drugs, osteoporosis remains underdiagnosed and undertreated, leaving over 2 million high-risk Italian women without treatment. This paper aims to identify and propose key improvements in the management of osteoporosis, focusing particularly on the critical issues related to the use of anabolic drugs in secondary prevention, according to the current Italian Medicines Agency (AIFA) Note 79. The Expert Panel, composed of nine recognized Italian experts in rheumatology, analyzed current practices, prescribing criteria, and the most recent literature. Three main reasons for revising the indications on pharmacological treatment of osteoporosis were identified: inadequate treatment of osteoporosis, new evidence regarding frontline placement of anabolics in high-risk conditions, and emerging sequential or combined strategies. The proposed improvements include the adoption of the Derived Fracture Risk Assessment algorithm for accurate fracture risk assessment, revision of AIFA Note 79 to reflect current evidence, improved prescribing appropriateness, broader access to anabolic agents, and the provision of sequential therapies with antiresorptives for teriparatide. These changes aim to enhance patient outcomes, streamline healthcare processes, and address the high percentage of undertreated individuals. This expert opinion emphasizes the importance of the appropriate use of anabolic drugs to reduce FF and associated costs while ensuring the sustainability of the National Health Service. The proposed recommendations are in line with the latest scientific evidence, providing a comprehensive strategy to optimize the management of osteoporosis in Italy. On behalf of the Study Group on Osteoporosis and Skeletal Metabolic Diseases of the Italian Society of Rheumatology.