Views of healthcare professionals regarding barriers and facilitators for a Fracture Liaison Service in Malaysia

A study in Malaysia emphasized the necessity of a FLS to enhance secondary fracture prevention and identified several challenges, including the lack of confidence among nurses in taking up the role of FLS coordinator, the need to implement the service within the constraints of limited resources, and the lack of prescribing rights for antiosteoporosis medications among primary care physicians.

A Fracture Liaison Service (FLS) is a coordinator-based model developed to reduce subsequent fractures and mortality by increasing the diagnosis of osteoporosis and improving its treatment. This qualitative study aimed to explore the views of healthcare professionals regarding the barriers and facilitators for the implementation of a FLS in Malaysia. Four groups of participants were recruited: doctors (geriatricians, surgeons, endocrinologists etc., nurses, pharmacists and policymakers.

The results of the study indicated that:

• The participants considered that delivery of secondary fracture prevention was adequate for hip fracture patients, as they were co-managed by members of the orthopaedics and geriatric medicine team. However, patients with non-hip fragility fractures were not included, potentially resulting in a disparity in care.
• The policymaker expressed that while FLS was important, it was not considered urgent.
• The participants thought that FLS had many benefits, and therefore supported the need for its implementation. It was also perceived as cost-effective. They emphasised the need for support from relevant stakeholders to ensure successful FLS implementation with a multidisciplinary team.
• The participants felt that the FLS should not be too champion-driven, but instead should be incorporated into routine clinical service.
• Orthopaedic surgeons were identified as key implementation stakeholders and most doctors believed that nurses were the most suitable candidates to be FLS coordinators. Nurses lacked the confidence to take up this role as they felt that it required a person with leadership qualities to effectively coordinate the team.

According to the authors: ‘All participants believed that there was a need for a FLS to improve the delivery of secondary fracture prevention. Addressing concerns such as lack of confidence among nurses and lack of awareness can help improve FLS sustainability’. 

Click here to read the study!