A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial

Emma L Healey,Krysia S Dziedzic,Mark Porcheret,Chris J Main,Sarah Ryan,Andrew Morden,Gretl A Mchugh,Andrew G Finney

doi:10.1186/s12875-016-0568-y

Abstract

BackgroundDespite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a GP about a musculoskeletal condition such as OA. Consequently this may provide an opportunity for practice nurses to take an active role in helping patients manage their condition. A nurse led clinic for supporting patients with OA was developed for the MOSAICS study investigating how to implement the NICE 2014 OA Guideline core recommendations. This paper has two main objectives, firstly to provide an overview of the nurse-led OA clinic, and secondly to describe the development, key learning objectives, content and impact of the training to support its delivery.MethodsA training programme was developed and delivered to provide practice nurses with the knowledge and skill set needed to run the nurse-led OA clinic. The impact of the training programme on knowledge, confidence and OA management was evaluated using case report forms and pre and post training questionnaires.ResultsThe pre-training questionnaire identified a gap between what practice nurses feel they can do and what they should be doing in line with NICE OA guidelines. Evaluation of the training suggests that it enabled practice nurses to feel more knowledgeable and confident in supporting patients to manage their OA and this was reflected in the clinical management patients received in the nurse-led OA clinics.ConclusionsA significant gap between what is recommended and what practice nurses feel they can currently provide in terms of OA management was evident. The development of a nurse training programme goes some way to develop a system in primary care for delivering the core recommendations by NICE.Trial registrationThe cluster trial linked to this training was conducted from May 2012 through February 2014 by the Arthritis Research UK Primary Care Centre, Keele University, UK (Trial registration number ISRCTN06984617).Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0568-y) contains supplementary material, which is available to authorized users.

Highlights

Despite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a general practitioner (GP) about a musculoskeletal condition such as OA
Baseline characteristics of the practice nurses involved in the Managing Osteoarthritis in Consultations (MOSAICS) trial Of those invited to complete the baseline questionnaire, 21 (84%) nurses responded
This paper provides the rationale for the nurse-led OA clinic, including the model OA consultation and the associated training programme, and describes the development, content and impact of the training programme which was devised to enable nurses to encourage a patient centred approach to increase the uptake of the National Institute for Health and Care Excellence (NICE) OA core treatments [10, 11], and was tested in the MOSAICS trial [16]

Summary

Introduction

Despite a lack of service provision for people with osteoarthritis (OA), each year 1 in 5 of the general population consults a GP about a musculoskeletal condition such as OA. This may provide an opportunity for practice nurses to take an active role in helping patients manage their condition. A nurse led clinic for supporting patients with OA was developed for the MOSAICS study investigating how to implement the NICE 2014 OA Guideline core recommendations. This guideline was subsequently updated in 2014 [11] and the NICE Quality Standards for OA were produced the following year [12], both of which recommend core treatments as a priority for implementation

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Discussion

Conclusion