Abstract

Background: Bisphosphonate related osteonecrosis of the jaw (BRONJ), is a rare, yet significant, adverse effect of bisphosphonate therapy. A multidisciplinary approach to the prevention of BRONJ is recommended due to the difficulties in treating the condition and the significant morbidity associated with a diagnosis. Current evidence suggests that practitioners have limited knowledge of the condition and that preventative strategies are frequently not implemented.
Objective: To explore the attitudes and perceptions of general medical practitioners and community pharmacists, on the risks and preventative strategies for the development of bisphosphonate related osteonecrosis of the jaw.
Design: Qualitative interview study
Participants: 8 community pharmacists and 7 general medical practitioners. Setting: Primary Care in the North East and Cumbria.
Methods: Interviews were audio recorded and transcribed verbatim; a grounded theory approach, with constant comparison, concurrent data collection and analysis was utilised. Framework analysis was used to focus and develop emerging concepts.
Results: 4 inter-related themes emerged: (1) Uncertain knowledge – limited exposure to BRONJ, awareness of the implications of a diagnosis, risk factors and preventative strategies. (2) Patient specific – complexity of patients, patient education and prioritising aspects of care. (3) Wider context – Lack of communication and referral processes between professions, work loading pressures, access and patient receptivity to dental services. (4) Professional – Professional roles and responsibilities, authority and educational initiatives
Conclusions: Current practice does not facilitate collaborative care in the prevention of BRONJ. Strategies to improve interprofessional prevention involving pharmacists, general medical practitioners, dentists and patients are required to reduce the incidence of BRONJ.