Skip to main content
Top
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Enhancing delivery of osteoarthritis care in the general practice consultation: evaluation of a behaviour change intervention

Authors: Mark Porcheret, Chris Main, Peter Croft, Krysia Dziedzic

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Professionally-focussed behaviour change intervention (BCI) workshops were utilised in the Management of OsteoArthritis in Consultations (MOSAICS) trial investigating the feasibility of implementing the National Institute for Health and Care Excellence (NICE) Osteoarthritis (OA) Guideline in general practice. The workshops aimed to implement the general practitioner (GP) component of the trial intervention: an enhanced consultation for patients presenting with possible OA. This study presents an evaluation of the BCI workshops on GP competency in conducting these enhanced consultations.

Methods

A before-and-after evaluation of the workshops, delivered to GPs participating in the intervention arm of the MOSAICS trial, using video-recorded GP consultations with simulated OA patients. GPs attended four workshops, which had been developed using an implementation framework. Videos were undertaken at three time-points (before workshops and at one- and five-months after) and were assessed by independent observers, blinded to time points, for GP competency in undertaking 14 predetermined consultation tasks.

Results

Videos of 15 GPs were assessed. GP competency increased from a median of seven consultation tasks undertaken by each GP at baseline to 11 at both time-points after the workshops. Specific tasks which were undertaken more frequently after the workshops related to explaining that OA is treatable and not inevitably progressive, eliciting and addressing patient expectations of the consultation, and providing written OA information. However, the use of the word “osteoarthritis” in giving the diagnosis of OA was not enhanced by the workshops.

Conclusions

BCI workshops can enhance GP competency in undertaking consultations for OA. Further initiatives to implement the NICE OA Guideline and enhance the care of people with OA in primary care can be informed by the content and delivery of the workshops evaluated in this study.
Appendix
Available only for authorised users
Literature
1.
go back to reference Thomas E, Peat G, Croft P. Defining and mapping the person with osteoarthritis for population studies and public health. Rheumatology (Oxford). 2014;53(2):338–45.CrossRef Thomas E, Peat G, Croft P. Defining and mapping the person with osteoarthritis for population studies and public health. Rheumatology (Oxford). 2014;53(2):338–45.CrossRef
2.
go back to reference Jordan KP, Joud A, Bergknut C, Croft P, Edwards JJ, Peat G, et al. International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden. Ann Rheum Dis. 2014;73(1):212–8.CrossRefPubMed Jordan KP, Joud A, Bergknut C, Croft P, Edwards JJ, Peat G, et al. International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden. Ann Rheum Dis. 2014;73(1):212–8.CrossRefPubMed
3.
go back to reference Conaghan PG, Dickson J, Grant RL, Guideline DG. Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ. 2008;336(7642):502–3.CrossRefPubMedPubMedCentral Conaghan PG, Dickson J, Grant RL, Guideline DG. Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ. 2008;336(7642):502–3.CrossRefPubMedPubMedCentral
4.
go back to reference Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64(5):669–81.CrossRefPubMed Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64(5):669–81.CrossRefPubMed
5.
go back to reference Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62(12):1145–55.CrossRefPubMedPubMedCentral Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62(12):1145–55.CrossRefPubMedPubMedCentral
6.
go back to reference Steel N, Hardcastle AC, Clark A, Mounce LT, Bachmann MO, Richards SH, et al. Self-reported quality of care for older adults from 2004 to 2011: a cohort study. Age Ageing. 2014;43(5):716–20.CrossRefPubMedPubMedCentral Steel N, Hardcastle AC, Clark A, Mounce LT, Bachmann MO, Richards SH, et al. Self-reported quality of care for older adults from 2004 to 2011: a cohort study. Age Ageing. 2014;43(5):716–20.CrossRefPubMedPubMedCentral
7.
go back to reference Porcheret M, Jordan K, Jinks C, Croft P. Primary care rheumatology society. Primary care treatment of knee pain--a survey in older adults. Rheumatology (Oxford). 2007;46(11):1694–700.CrossRef Porcheret M, Jordan K, Jinks C, Croft P. Primary care rheumatology society. Primary care treatment of knee pain--a survey in older adults. Rheumatology (Oxford). 2007;46(11):1694–700.CrossRef
8.
go back to reference Jinks C, Ong BN, Richardson JC. A mixed methods study to investigate needs assessment for knee pain and disability. Population and individual perspectives. BMC Musculoskelet Disord. 2007;8:59.CrossRefPubMedPubMedCentral Jinks C, Ong BN, Richardson JC. A mixed methods study to investigate needs assessment for knee pain and disability. Population and individual perspectives. BMC Musculoskelet Disord. 2007;8:59.CrossRefPubMedPubMedCentral
9.
go back to reference Paskins Z, Sanders T, Hassell AB. Comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA: a narrative review. BMC Fam Pract. 2014;15:46.CrossRefPubMedPubMedCentral Paskins Z, Sanders T, Hassell AB. Comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA: a narrative review. BMC Fam Pract. 2014;15:46.CrossRefPubMedPubMedCentral
10.
go back to reference Paskins Z, Sanders T, Croft PR, Hassell AB. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13(6):537–44.CrossRefPubMedPubMedCentral Paskins Z, Sanders T, Croft PR, Hassell AB. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13(6):537–44.CrossRefPubMedPubMedCentral
11.
go back to reference Coxon D, Frisher M, Jinks C, Jordan K, Paskins Z, Peat G. The relative importance of perceived doctor's attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study. BMJ Open. 2015;5(10):e009625,2015–009625.CrossRef Coxon D, Frisher M, Jinks C, Jordan K, Paskins Z, Peat G. The relative importance of perceived doctor's attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study. BMJ Open. 2015;5(10):e009625,2015–009625.CrossRef
13.
go back to reference Dziedzic KS, Healey EL, Porcheret M, Ong B, Main CJ, Jordan KP, et al. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care - the management of OsteoArthritis in consultations (MOSAICS) study protocol. Implement Sci. 2014;9(1):95.CrossRefPubMedPubMedCentral Dziedzic KS, Healey EL, Porcheret M, Ong B, Main CJ, Jordan KP, et al. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care - the management of OsteoArthritis in consultations (MOSAICS) study protocol. Implement Sci. 2014;9(1):95.CrossRefPubMedPubMedCentral
14.
go back to reference Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K. Development of a behaviour change intervention: a case study on the practical application of theory. Implement Sci. 2014;9(1):42.CrossRefPubMedPubMedCentral Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K. Development of a behaviour change intervention: a case study on the practical application of theory. Implement Sci. 2014;9(1):42.CrossRefPubMedPubMedCentral
15.
go back to reference Hrisos S, Eccles M, Francis J, Dickinson H, Kaner E, Beyer F, et al. Are there valid proxy measures of clinical behaviour? A systematic review. Implement Sci. 2009;4(1):37.CrossRefPubMedPubMedCentral Hrisos S, Eccles M, Francis J, Dickinson H, Kaner E, Beyer F, et al. Are there valid proxy measures of clinical behaviour? A systematic review. Implement Sci. 2009;4(1):37.CrossRefPubMedPubMedCentral
16.
go back to reference Rethans JJ, Norcini JJ, Baron-Maldonado M, Blackmore D, Jolly BC, LaDuca T, et al. The relationship between competence and performance: implications for assessing practice performance. Med Educ. 2002;36(10):901–9.CrossRefPubMed Rethans JJ, Norcini JJ, Baron-Maldonado M, Blackmore D, Jolly BC, LaDuca T, et al. The relationship between competence and performance: implications for assessing practice performance. Med Educ. 2002;36(10):901–9.CrossRefPubMed
17.
go back to reference Grol R, Wensing M, Eccles M. Improving patient care: the implementation of change in Clinical Practice. 2005. Grol R, Wensing M, Eccles M. Improving patient care: the implementation of change in Clinical Practice. 2005.
18.
go back to reference Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf. Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf. Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral
19.
go back to reference Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived Behavioural determinants to behaviour change techniques. Appl Psychol. 2008;57(4):660–80.CrossRef Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived Behavioural determinants to behaviour change techniques. Appl Psychol. 2008;57(4):660–80.CrossRef
20.
go back to reference Phillips A, Lewis L, McEvoy M, Galipeau J, Glasziou P, Moher D, et al. Development and validation of the guideline for reporting evidence-based practice educational interventions and teaching (GREET). BMC Med. Educ. 2016;16:237.CrossRefPubMedPubMedCentral Phillips A, Lewis L, McEvoy M, Galipeau J, Glasziou P, Moher D, et al. Development and validation of the guideline for reporting evidence-based practice educational interventions and teaching (GREET). BMC Med. Educ. 2016;16:237.CrossRefPubMedPubMedCentral
21.
go back to reference Porcheret M, Grime J, Main C, Dziedzic K. Developing a model osteoarthritis consultation: a Delphi consensus exercise. BMC Musculoskelet Disord. 2013;14:25.CrossRefPubMedPubMedCentral Porcheret M, Grime J, Main C, Dziedzic K. Developing a model osteoarthritis consultation: a Delphi consensus exercise. BMC Musculoskelet Disord. 2013;14:25.CrossRefPubMedPubMedCentral
22.
go back to reference Altman DG. Practical statistics for medical research. 1st ed. London: Chapman and Hall; 1991. Altman DG. Practical statistics for medical research. 1st ed. London: Chapman and Hall; 1991.
23.
go back to reference Siegel S, Castellan N. Nonparametric statistics for behavioural sciences. 2nd ed. New York: McGraw-Hill Book Company; 1988. Siegel S, Castellan N. Nonparametric statistics for behavioural sciences. 2nd ed. New York: McGraw-Hill Book Company; 1988.
24.
go back to reference Ravaud P, Flipo RM, Boutron I, Roy C, Mahmoudi A, Giraudeau B, et al. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ. 2009;338:b421.CrossRefPubMedPubMedCentral Ravaud P, Flipo RM, Boutron I, Roy C, Mahmoudi A, Giraudeau B, et al. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ. 2009;338:b421.CrossRefPubMedPubMedCentral
25.
go back to reference Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J. Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007;57(8):1390–7.CrossRefPubMed Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J. Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007;57(8):1390–7.CrossRefPubMed
26.
go back to reference Chassany O, Boureau F, Liard F, Bertin P, Serrie A, Ferran P, et al. Effects of training on general practitioners’ management of pain in osteoarthritis: a randomized multicenter study. J Rheumatol. 2006;33(9):1827–34.PubMed Chassany O, Boureau F, Liard F, Bertin P, Serrie A, Ferran P, et al. Effects of training on general practitioners’ management of pain in osteoarthritis: a randomized multicenter study. J Rheumatol. 2006;33(9):1827–34.PubMed
27.
go back to reference Rollnick S, Kinnersley P, Butler C. Context-bound communication skills training: development of a new method. Med Educ. 2002;36(4):377–83.CrossRefPubMed Rollnick S, Kinnersley P, Butler C. Context-bound communication skills training: development of a new method. Med Educ. 2002;36(4):377–83.CrossRefPubMed
28.
go back to reference Rollnick S, Seale C, Kinnersley P, Rees M, Butler C, Hood K. Developing a new line of patter: can doctors change their consultations for sore throat? Med Educ. 2002;36(7):678–81.CrossRefPubMed Rollnick S, Seale C, Kinnersley P, Rees M, Butler C, Hood K. Developing a new line of patter: can doctors change their consultations for sore throat? Med Educ. 2002;36(7):678–81.CrossRefPubMed
29.
go back to reference Cals JW, Scheppers NA, Hopstaken RM, Hood K, Dinant GJ, Goettsch H, et al. Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice. Patient Educ Couns. 2007;68(3):270–8.CrossRefPubMed Cals JW, Scheppers NA, Hopstaken RM, Hood K, Dinant GJ, Goettsch H, et al. Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice. Patient Educ Couns. 2007;68(3):270–8.CrossRefPubMed
30.
go back to reference Kingsbury SR, Conaghan PG. Current osteoarthritis treatment, prescribing influences and barriers to implementation in primary care. Prim Health Care Res Dev. 2012;13(4):373–81.CrossRefPubMed Kingsbury SR, Conaghan PG. Current osteoarthritis treatment, prescribing influences and barriers to implementation in primary care. Prim Health Care Res Dev. 2012;13(4):373–81.CrossRefPubMed
31.
go back to reference Cottrell E, Roddy E, Foster NE. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review. BMC Fam Pract. 2010;11:4. 2296-11-4CrossRefPubMedPubMedCentral Cottrell E, Roddy E, Foster NE. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review. BMC Fam Pract. 2010;11:4. 2296-11-4CrossRefPubMedPubMedCentral
Metadata
Title
Enhancing delivery of osteoarthritis care in the general practice consultation: evaluation of a behaviour change intervention
Authors
Mark Porcheret
Chris Main
Peter Croft
Krysia Dziedzic
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0715-8

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue