A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention.

Introduction: Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol.
Methods and Analysis: We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team.
Ethics and Dissemination: Ethical approval was obtained from NHS North West-Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.
Competing Interests: Competing interests: ZP has received financial support for non-promotional consultancy for UCB Pharma.EC has received the following research grants: Unrestricted research grant from Royal Osteoporosis Society Ref 505. Three additional unrestricted research grants from Royal Osteoporosis Society Res 510, 511 and 462. Unrestricted research grant from NIHR; RfPB NIHR 203026. HQIP contract to analyse the national Joint Registry. Honorarium from the Bone Research Society for lecturing at the Clinical Training Course in 2022 and 2023. Honorarium from Danske Fysiorapeuter for lecturing at the Danish Osteoporosis Course for Physiotherapists in 2021, 2022 and 2023. Trustee of the Royal Osteoporosis Society since 2023 (unpaid).
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