Abstract
BackgroundProfessionally-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.MethodsA 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.ResultsVideos 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.ConclusionsBCI 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.
Highlights
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
One aspect of suboptimal OA care is the conduct by general practitioners (GPs) of consultations for older patients presenting with peripheral joint pain, those likely to have OA
This study aimed to evaluate the success of BCI workshops to implement delivery by GPs of the “enhanced initial OA consultation” by measuring workshop impact on GP competency to conduct these consultations using video-recorded consultations with simulated patients
Summary
In the UK the National Institute for Health and Care Excellence (NICE) recommends that: OA should be diagnosed clinically; a holistic assessment should be undertaken; OA self-management should be supported; core treatments should be information, advice on activity and exercise and, if relevant, interventions to achieve weight loss; non-pharmacological and pharmacological treatments, and referral for consideration of joint should be used as additional treatment options [3, 12] To implement these recommendations in UK general practice they would need to be acted on by GPs – to whom the majority of people with possible OA first present. Given current evidence of suboptimal GP consultations for OA, implementation of NICE OA guidance would need to include activities to enhance GP OA consultations
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