OBJECTIVES

The aim of this paper is to quantify the relative value that the patient attaches to the difficulties and facilities he / she has experienced in implementing a personal approach to secondary prevention of osteoporosis in France.

METHODS

The study implement a sequential mixed study protocols with a predominance of the quantitative dimension. A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients’ interviews. A list of 21 barriers and 21 expectations were identified. These were presented to 324 subjects with osteoporotic fracture, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Mean importance scores of attributs were calculated and ranked. A Bayesian hierarchical model was also performed in order to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles.

RESULTS

Seven barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, “my fracture is not related to osteoporosis”, was significantly more important than all the others (mean importance score: 0.45 [95%CI: 0.33 – 0.56]. For expectations, no clear hierarchy of attributes was identified. In the Bayesian analysis, the average RIS of the 21 barriers was 4.762. Three barriers (6, 19 and 1) stand out from all others in this Bayesian ranking and score above the average RIS, consistent with the findings of the descriptive analysis. Latent class analysis discriminated three classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system).

CONCLUSIONS

Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals and coordination of care.