Abstract
BackgroundPrevious research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8–12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model.Methods/designA cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants’ treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER).DiscussionThe results from the present study will add to the current knowledge on tailored strategies, which aims to improve the uptake of evidence-based OA care recommendations and improve the quality of OA care in primary health care. The new knowledge can be used in national and international initiatives designed to improve the quality of OA care.Trial registrationClinicalTrials.gov NCT02333656Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0353-7) contains supplementary material, which is available to authorized users.
Highlights
Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment
The results from the present study will add to the current knowledge on tailored strategies, which aims to improve the uptake of evidence-based OA care recommendations and improve the quality of OA care in primary health care
The general practitioner (GP) and the PTs in the six participating municipalities in Øvre Romerike will switch from control to intervention phase in a randomized order
Summary
This study aims to implement the SAMBA model for integrated OA care aiming to improve professional practice and patient outcomes and reduce non-desired events The model will be implemented and evaluated in primary health care in six municipalities in a stepped wedge cluster randomized controlled trial. The study includes close collaboration with international experts, which will contribute in the study and share relevant experiences from similar implementation studies. This large cluster stepped wedge randomized trial will add to the current knowledge on structured approaches aiming to improve the uptake of evidence-based OA care recommendations in primary health care, which may improve the quality of OA care. Additional file 2: Focus group interviews.This file contains the results from three focus group interviews aiming to identify potential barriers and facilitators for the SAMBA model implementation and the workshop training packages. All authors have critically read and modified the study protocol and previous drafts of the manuscript and have approved the final version
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