Effect of a model consultation informed by guideline on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care

Jordan, Kelvin; Edwards, J.J.; Porcheret, M.; Healey, Emma; Jinks, Clare; Bedson, J.; Clarkson, K.; Hay, Elaine; Dziedzic, Krysia

Abstract

Objective
To determine the effect of a model osteoarthritis (OA) consultation (MOAC) informed by National Institute for Health and Care Excellence (NICE) recommendations compared with usual care on recorded quality of care of clinical OA in general practice.

Design
Two-arm cluster randomised controlled trial.

Setting
Eight general practices in Cheshire, Shropshire, or Staffordshire UK.

Participants
General practitioners and nurses with patients consulting with clinical OA.

Intervention
Following six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged =45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators.

Outcomes
Quality of OA care over six months recorded in the medical record.

Results
1851 patients consulted in baseline period (1015 intervention; 836 control); 1960 consulted following randomisation (1118 intervention; 842 control). At baseline wide variations in quality of care were noted. Post-randomisation increases were found for written advice on OA (4–28%), exercise (4–22%) and weight loss (1–15%) in intervention practices but not controls (1–3%). Intervention practices were more likely to refer to physiotherapy (10% vs 2%, odds ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38).

Conclusions
The intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care.

Citation

Jordan, K., Edwards, J., Porcheret, M., Healey, E., Jinks, C., Bedson, J., …Dziedzic, K. (2017). Effect of a model consultation informed by guideline on recorded quality of care of osteoarthritis (MOSAICS): a cluster randomised controlled trial in primary care. Osteoarthritis and Cartilage, 25(10), 1588-1597. https://doi.org/10.1016/j.joca.2017.05.017

• Journal Article Type: Article
• Acceptance Date: May 27, 2017
• Online Publication Date: Jun 4, 2017
• Publication Date: 2017-10
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 10
• Pages: 1588-1597
• DOI: https://doi.org/10.1016/j.joca.2017.05.017
• Keywords: osteoarthritis, general practice, implementation, primary care, guidelines
• Publisher URL: https://doi.org/10.1016/j.joca.2017.05.017