Implementing national standards for the management of osteoarthritis in primary care

Person-centred care

Partner Organisations

  • Keele University

Themes

  • Digital health
  • Education and skills
  • Innovation and adoption
  • Patient safety

Date Initiated

31 March 2015

Project Status

In Progress

Improving the management of osteoarthritis in general practice in the West Midlands through the implementation of key innovations – OA e-template; patient led self-management resources and practice nurse consultation.

Osteoarthritis (OA) is the commonest musculoskeletal condition in older people. NICE guidelines (NICE, 2014) prioritised core interventions: access to information and advice; exercise and physical activity; and weight loss (if overweight). Despite clear guidance on supporting patients in self-management, these guidelines have not been systematically implemented or audited against national standards. An implementation project in Shropshire CCG has built upon the findings from the MOSAICs research programme at Keele University. addressing the unmet needs of patients and healthcare professionals in the management of primary care for OA. The person-centred care theme is now able to offer the learning and toolkit from this pilot project across the West Midlands. 

This programme encompasses:

  • Installation of an OA e-template in GP clinical records systems to prompt the recording of OA and care 
  • Provision of an OA guidebook (a guidebook developed by patients for patients)
  • Delivery of OA consultations with GPs/practice nurses that is transferable to other long term conditions (LTCs)
  • Training materials to support GPs and practice nurses in primary care management of OA, facilitating support for self-management
  • Audit of quality primary care for OA against national standards of OA care using a patient-generated quality indicators questionnaire and OA e-template. 

Programme Outcomes

This innovation will support primary care in addressing the unmet needs of adults consulting for OA. This will be achieved through the provision of innovations to support the systematic implementation of the NICE 2014 guidelines for OA at practice level. Practices have identified orthopaedic referrals as a high volume area and wish to adopt a NICE-recommended model of primary care for OA as an alternative to the more traditional pathway of x-ray, diagnosis, referral and joint replacement. Proactively managing OA improves the quality of care for patients, may reduce the incidence of arthroplasty and will improve outcomes following arthroplasty. The aim is to enhance patients’ quality of care without reverting to surgical treatment unless all core options have been explored.

This project aims to implement a model of supported self-management for OA, reduce clinical variation through the use of the OA e-template, train “trainers” to spread the adoption of the model OA consultation, and evaluate the impact of this at practice level and through patient audit of quality care.  

The project seeks to deliver the following improvements:

  • Reduce clinical variation, through the successful implementation of an electronic OA e-template to guide practice
  • Improve evidence-based practice through i) supported self-management; ii) “training the trainers”; iii) local champions; iv) training GPs and practices nurses in the OA consultation
  • Improve patient satisfaction and clinical outcomes through implementation of NICE guidelines, nurse-led LTC clinics and access to written information (OA guidebook).

The success of the innovation can be evaluated in a number of ways, including:

  • Number of practices engaged and clinicians accessing training
  • Provision of practice nurse led consultations to support patients with OA/LTC
  • Uptake of core NICE interventions captured via the electronic template. Main outcomes: frequency of template triggering, achievement of quality indicators during the consultation (assessment of pain and function, assessment for first-line analgesics, provision of information, exercise advice, consideration of physiotherapy referral, weight loss advice) and change in routinely recorded clinician behaviour (diagnostic coding, prescribing, referral, use of radiography and weight records) compared with prior to template installation
  • Audit of patient-reported quality of OA care
  • Feedback regarding the training.

Programme Lead

Rhian Hughes, Krysia Dziedzic and Helen Duffy
e: h.c.duffy@keele.ac.uk
t: 01782 733976