Abstract
BackgroundOsteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective, the aim of this study was to understand the uptake of a clinical innovation for osteoarthritis and explore the journey from a clinical trial to implementation.MethodsThis study used two methods: secondary analysis of focus groups undertaken with general practice staff from the Managing OSteoArthritis in ConsultationS research trial, which investigated the effectiveness of an enhanced osteoarthritis consultation, and interviews with stakeholders from an implementation project which started post-trial following demand from general practices. Data from three focus groups with 21 multi-disciplinary clinical professionals (5–8 participants per group), and 13 interviews with clinical and non-clinical stakeholders, were thematically analysed utilising the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, in a theoretically informative approach. Public contributors were involved in topic guide design and interpretation of results.ResultsIn operationalising implementation of an innovation for osteoarthritis following a trial, the importance of a whole practice approach, including the opportunity for reflection and planning, were identified. The end of a clinical trial provided opportune timing for facilitating implementation planning. In the context of osteoarthritis in primary care, facilitation by an inter-disciplinary knowledge brokering service, nested within an academic institution, was instrumental in supporting ongoing implementation by providing facilitation, infrastructure and resource to support the workload burden. ‘Instinctive facilitation’ may involve individuals who do not adopt formal brokering roles or fully recognise their role in mobilising knowledge for implementation. Public contributors and lay communities were not only recipients of healthcare innovations but also potential powerful facilitators of implementation.ConclusionThis theoretically informed knowledge mobilisation study into the uptake of a clinical innovation for osteoarthritis in primary care has enabled further characterisation of the facilitation and recipient constructs of i-PARIHS by describing optimum timing for facilitation and roles and characteristics of facilitators.
Highlights
Osteoarthritis is a leading cause of pain and disability worldwide
This study makes a theoretical contribution to i-PARIHS by illuminating different roles and activities of facilitation in primary care and illustrating how public contributors can be recipients and facilitators of implementation ‘Instinctive’ facilitation occurred when key individuals, including patients, were unaware of their role in knowledge mobilisation, utilising tacit knowledge to support implementation Conditions deemed ‘low-priority’ by stakeholders may require more dedicated facilitation The end of a trial is an important opportunity for facilitation to trigger knowledge mobilisation and catalyse implementation An inter-disciplinary knowledge-brokering service within a clinical-academic unit provided infrastructure and resource to facilitate knowledge mobilisation and support implementation
This study aimed to understand the uptake of a clinical innovation for OA and explore the transition of knowledge from a clinical trial to implementation from a Knowledge mobilisation (KM) perspective, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework in a theoretically informative approach
Summary
Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. Osteoarthritis (OA) is the most common joint disorder in the Western world. It is a leading cause of pain, loss of function and disability worldwide and is predominantly managed in primary care [1]. Despite international evidence-based guidelines that support best practice, management of OA remains suboptimal [2, 3]. Effective non-surgical models of OA care do not inevitably translate to improved clinical practice that benefits patients [5,6,7]. Where post-trial implementation does occur, little is known about how this is achieved in different contexts [8]
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