Fracture liaison services (FLS) have been shown to prevent efficiently subsequent fragility fractures (FF). However, very few studies have examined their implementation in depth. The purpose of this research was to identify factors influencing the implementation of a FLS at three sites in Quebec, Canada. From 2013 to 2015, individual and group interviews focused on experiences of FLS stakeholders, including implementation committee members, coordinators, and orthopaedic surgeons and their teams. Emerging key implementation factors were triangulated with the FLS patients' clinico-administrative data. The Consolidated Framework for Implementation Research guided the analysis of perceived factors influencing four intervention outputs: investigation of FF risk (using the FRAX score), communication with the participant primary care provider, initiation of anti-osteoporosis medications (when relevant), and referral to organized fall prevention activities (either governmental or community based). Among the 454 FLS patients recruited to the intervention group, 83% were investigated for FF risk, communication with the primary care provider was established for 98% of the participants, 54% initiated medication, and 35% were referred to organized fall prevention activities. Challenges related to restricted rights to prescribe medication and access to organized fall prevention activities were reported. FLS coordinator characteristics to overcome those challenges included self-efficacy beliefs, knowledge of community resources, and professional background. This study highlighted the importance of enabling access to services for subsequent FF prevention, consolidating the coordinator's role to facilitate a more integrated intervention, and involving local leaders to promote the successful implementation of the FLS.

中文翻译：

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实施骨折随访联络服务：关键利益相关者的观点。

骨折联络服务（FLS）已被证明可以有效地防止随后的脆性骨折（FF）。但是，很少有研究深入研究其实施。这项研究的目的是找出影响加拿大魁北克省三个地点FLS实施的因素。从2013年到2015年，个人和小组访谈的重点是FLS利益相关者的经验，包括实施委员会成员，协调员，整形外科医生及其团队。新兴的关键实施因素与FLS患者的临床管理数据进行了三角划分。实施研究综合框架指导了影响四个干预输出的感知因素的分析：FF风险调查（使用FRAX评分），与参与方初级保健提供者的沟通，开始抗骨质疏松症药物（如果相关），并转介到有组织的预防跌倒活动（基于政府或社区）。在纳入干预组的454名FLS患者中，对FF风险进行了83％的调查，与98％的参与者建立了与初级保健提供者的沟通，54％的患者开始用药，35％的患者参加了有组织的预防跌倒活动。报告了与处方药的受限权利和参加有组织的预防跌倒活动有关的挑战。克服这些挑战的FLS协调员的特征包括自我效能感，社区资源知识和专业背景。这项研究强调了为随后的预防FF提供服务的重要性，巩固了协调员的能力。