Addressing the needs of Malaysian postmenopausal women : A pharmacist-led osteoporosis screening programme in a teaching hospital primary-care clinic

Toh, Li Shean (2016) Addressing the needs of Malaysian postmenopausal women : A pharmacist-led osteoporosis screening programme in a teaching hospital primary-care clinic. PhD thesis, University of Nottingham.

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In Malaysia, the prevalence of osteoporosis in women age >45 years is approximately 1 in 4 making it a major public health concern. Osteoporosis is usually asymptomatic in its early stages. Consequently, women who may have osteoporosis remain unidentified. This may lead to unwanted fractures. Fractures are associated with a reduction in quality of life. There is a 3-fold increased risk of death within 5 years in those who fracture. It is therefore imperative to encourage prevention and screening programmes which aid in early detection of osteoporosis. Current research suggests that many individuals with fragility fractures do not undergo appropriate screening and do not engage in preventive health behaviours.

Pharmacists can work in collaboration with doctors to screen for osteoporosis, to educate patients on their osteoporosis risk, and to empower patients to take osteoporosis preventive measures. It is with this belief that we conducted this study to determine the effectiveness of a pharmacist osteoporosis screening programme in postmenopausal women.

This study design was developed based on the United Kingdom Medical Research Council’s Framework of developing and evaluating complex intervention. Hence, this research project was divided into three phases: phase one was to explore the perceptions of the stakeholders for conducting an osteoporosis screening programme, phase two was to develop tools for the osteoporosis screening programme whilst phase three was to conduct the a feasibility study on the osteoporosis screening programme.

Phase one aimed to answer three research questions. The first research question was to explore the barriers and facilitators towards conducting an osteoporosis screening programme. Seven main barriers to the implementation of an osteoporosis screening programme were identified: governmental, organizational and management, work environment, team, task, individual and patient factors. The patient factors were targeted for our intervention.

The second research question explored the role of the Malaysian pharmacist in osteoporosis screening. Pharmacists were principally perceived by all participants to be suppliers of medication, although there was some recognition of roles in providing medication advice. Nonetheless, doctors, nurses and policy makers were eager for pharmacists to be more proactive via inter-professional collaboration in osteoporosis screening, prevention advice and disease management.

The third research question aimed to explore the components for an acceptable, practical and sustainable osteoporosis screening programme. We systematically identified four intervention (environment restructuring, education, persuasion, enablement) components to develop an acceptable, practical and sustainable osteoporosis programme. The “interventional package” consisted of counselling sessions, osteoporosis risk assessment and bone mineral density.

In phase two, the Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) and Osteoporosis Prevention and Awareness Tool (OPAAT) were developed and validated. Both the OPAAT and SQOP were found to be valid and reliable to assess patients’ knowledge of osteoporosis and patients’ satisfaction towards the pharmacist screening programme. Additionally, six osteoporosis risk assessment tools were also validated among Malaysian postmenopausal women. Our results identified that the Osteoporosis Screening tool for Asians (OSTA) was the most suitable risk assessment tool as it had a sensitivity of 81.3% and specificity of 41.0% at an empirical cut-off point of ≤0. A pharmacist-led osteoporosis screening intervention package which consisted of the ‘intervention package’ and collaboration between the doctors and pharmacists was developed and finalized.

Phase three was a feasibility study of the developed pharmacist-led osteoporosis screening programme. Based on scientific, process, resources and management assessment the programme was found to be feasible in the Malaysian primary care setting. This was a good start for the implementation of a population-based osteoporosis screening programme in Malaysia as there was currently no such programme available. Future research should involve a randomized controlled trial to assess the effectiveness of the programme.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Anderson, Claire
Lai, Pauline Siew Mei
Wong, Kok Thong
Low, Bee Yean
Keywords: osteoporosis, screening, intervention, postmenopausal, pharmacist, prevention, primary care,
Subjects: R Medicine > RC Internal medicine
R Medicine > RS Pharmacy and materia medica
Faculties/Schools: University of Nottingham, Malaysia > Faculty of Science and Engineering — Science > School of Pharmacy
Item ID: 30549
Depositing User: TOH, LI SHEAN
Date Deposited: 21 Dec 2016 09:14
Last Modified: 08 Dec 2017 01:53

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