Effect of a model consultation informed by guidelines on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care.

K.P Jordan,E.M Hay,C Jinks,K Clarkson,J.J Edwards,J Bedson,E.L Healey,K.S Dziedzic,M Porcheret

doi:10.1016/j.joca.2017.05.017

Abstract

SummaryObjectiveTo determine the effect of a model osteoarthritis (OA) consultation (MOAC) informed by National Institute for Health and Care Excellence (NICE) recommendations compared with usual care on recorded quality of care of clinical OA in general practice.DesignTwo-arm cluster randomised controlled trial.SettingEight general practices in Cheshire, Shropshire, or Staffordshire UK.ParticipantsGeneral practitioners and nurses with patients consulting with clinical OA.InterventionFollowing six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged ≥45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators.OutcomesQuality of OA care over six months recorded in the medical record.Results1851 patients consulted in baseline period (1015 intervention; 836 control); 1960 consulted following randomisation (1118 intervention; 842 control). At baseline wide variations in quality of care were noted. Post-randomisation increases were found for written advice on OA (4–28%), exercise (4–22%) and weight loss (1–15%) in intervention practices but not controls (1–3%). Intervention practices were more likely to refer to physiotherapy (10% vs 2%, odds ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38).ConclusionsThe intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care.Trial registration numberISRCTN06984617.

Highlights

We report here the practice-level results addressing the study question of whether the intervention increases the uptake of National Institute for Health and Care Excellence (NICE) OA recommendations by general practices taking part in MOSAICS, as measured by quality indicators of OA care in the practices' electronic health records (EHR)
MOSAICS was a mixed methods study with a two arm cluster randomised controlled trial conducted in eight general practices in Cheshire, Shropshire, or Staffordshire, UK
There were 1118 patients recorded with clinical OA during the six month trial period in the intervention practices, and 842 patients in the control practices (Fig. 1)

Summary

Introduction

K.P. Jordan et al / Osteoarthritis and Cartilage 25 (2017) 1588e1597 exercise and weight management1,3e6. The situation is similar[7,8] and a change in models of care for OA has been proposed[9]. A systematic review has previously identified some limited evidence to support primary care collaborative care models and multidisciplinary case management as complex interventions to improve OA care[10]. Strategies to improve quality of primary care for long-term conditions in the UK have included use of computerised templates and decision support systems[11], health trainers[12], promotion of self-management[13], and educational intervention[14]. Some risk factors for OA are addressed by the health trainer model (weight management, exercise/physical activity), there have been few successful attempts to enhance OA care in general practice

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Results

Conclusion