The management of osteoarthritis in general practice:
development and implementation of a model consultation

Porcheret, Mark Ernest Paul

Abstract

Background
People with osteoarthritis (OA) frequently consult general practitioners (GPs) for the problem but the care they receive in these consultations is often sub-optimal. The aim of the studies described in this thesis was to enhance GP clinical practice for OA by developing and implementing a model OA consultation for the initial contact between a GP and an older patient presenting with peripheral joint pain.

Methods
A consensus exercise was undertaken to develop the model OA consultation. This was followed by the development, and delivery in a series of workshops, of a behaviour change intervention to implement the model in practice. Impact of workshops was assessed by before-and-after methods on directly observed GP use of the model OA consultation in video-recorded consultations with
simulated patients, and by self-report measures (at baseline, and one and five months after). Learner
reactions and delivery in day-to-day practice were assessed.

Results
The model OA consultation consisted of 25 tasks for assessment and initial management. A four workshop series was developed and delivered to 24 GPs and included didactic, interactive and skills training (with simulated patients) sessions. The workshops addressed barriers and facilitators for change identified in the development of the behaviour change intervention. GP use of the model OA
consultation, by 15 GPs whose video-recorded consultations were assessed, was enhanced after workshops compared with before, evidenced by increased use of 14 tasks from a median of 7 tasks before to 11 after. Impact on self-report measures was inconclusive. Learner reactions were positive but delivery in day-to-day practice was limited.

Conclusion
A before and after study has demonstrated that GP use of a model OA consultation in a simulated setting can be enhanced. Further research and quality improvement initiatives will be needed to enhance use of the model OA consultation in day-to-day practice.

Citation

development and implementation of a model consultation