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Attitudes and perceptions of GPs and community pharmacists towards their role in the prevention of bisphosphonate-related osteonecrosis of the jaw: a qualitative study in the North East of England
  1. Andrew Sturrock1,
  2. Philip Preshaw2,
  3. Catherine Hayes1,
  4. Scott Wilkes1
  1. 1 Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
  2. 2 Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  1. Correspondence to Andrew Sturrock; andrew.sturrock{at}


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 significant morbidity and difficulty treating the condition. Current evidence suggests that both general practitioners (GPs) and community pharmacists have limited knowledge relating to BRONJ and that preventative strategies are rarely implemented.

Objective To explore the attitudes and perceptions of GPs and community pharmacists on the risks and preventative strategies for the development of BRONJ.

Design Interpretivist methodological approach using qualitative semistructured interviews.

Participants 9 community pharmacists and 8 GPs.

Setting Primary Care in North East England and Cumbria, UK.

Methods Using a Grounded Theory methodology and integrating a process of constant comparison in the iterative enrichment of data sets, semistructured interviews were undertaken, transcribed and analysed using framework analysis. Salient themes were identified and related back to extant literature in the field.

Results Four salient and inter-related themes emerged: (1) uncertain knowledge, indicating limited exposure of respondents to BRONJ, and limited awareness of the implications of its diagnosis, risk factors and preventative strategies; (2) patient specific, referring to the complexity of patients, patient education and prioritising aspects of care; (3) wider context, indicating a lack of interdisciplinary communication and referral processes between professions, workload pressures, access and patient receptivity to dental services; and (4) professional, reflecting professional roles and responsibilities, authority and educational initiatives

Conclusions Effective communication or collaborative care between GPs and community pharmacists for the prevention of BRONJ is not apparent. Interventions to mitigate against the risk of developing BRONJ and clarity of GP and community pharmacy roles are required.

  • Bisphosphonate-Related Osteonecrosis of the Jaw
  • General Practitioners
  • Pharmacists
  • Interdisciplinary Communication
  • Qualitative Research

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  • Contributors An interest in the subject area was developed by AS as an extension to the interprofessional learning opportunities delivered at the University of Sunderland School of Pharmacy. The multidisciplinary team was assembled to reduce bias and provide rigour in the investigation. AS and SW designed the study. AS recruited the participants and carried out the study. AS identified the thematic framework and interpreted the data. AS, SW, PP and CH reviewed and refined the data. AS wrote the paper and all authors revised it. AS received training in qualitative research skills by the research team and through attendance at a Qualitative Research Methods in Health Course at University College London.

  • Competing interests None declared.

  • Ethics approval University of Sunderland Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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