Table 1 Barriers to the implementation of osteoporosis and fracture prevention guidelines in long-term care facilities

Individual

• Knowledge

• Patients have impaired understanding of their condition.

• Staff members incorrectly dispense bisphosphonates.

• Habits

• Few staff members attend educational sessions.

Organization

• Regulations

• Vitamin D and calcium are inconsistently prescribed at the time of admission^a.

• Osteoporosis and fracture prevention strategies are not discussed during multidspilinary conferences and quarterly reviews^a.

• Information required for fracture risk assessment is difficult to obtain^a.

• Processes of care

• There is a limited medical history regarding osteoporosis and fractures available to LTC facility.

• The LTC facility does not examine changes in height on an annual basis.

• The recommendation of three servings of dairy per day is not followed.

• Resources

• Lack of information and educational resources prior to the ViDOS intervention^a

Social

• Authorities

• The process to change policies is cumbersome.

• Patient reactions

• The Patient or his/her family is not willing or unable to pay for vitamin D^a.