Background In spite of a high prevalence and community burden of osteoarthritis, treatment of this disease is still fare from the best evidence, especially in primary care1. Clinical guidelines are promising tools to improve this situation, but their impact in many ways depends on an educational intervention by means of which they are translated into practice. The possible implementation options include computer reminders, educational meetings, dissemination of the printed guidelines and patient brochures. Overall, educational interventions can improve professional performance approximately by 7–15% and patient’s outcomes by 3–5%2. There is no universal approach how to translate guidelines into practice, so the trials that evaluate different implementation strategies in a local context are of high importance.
Objectives To evaluate the long term patient outcomes and treatment preferences after the implementation of the national knee and hip osteoarthritis clinical guideline in primary care.
Methods Design: open pragmatic cluster randomized controlled trial. Participants: 16 general practitioners/clusters who completed the trial (10 from the intervention group, 6 represented usual care) included 92 patients with knee and hip osteoarthritis (63 in the intervention group, 29 in the usual care group). Intervention: one-day didactic educational meeting, provision of the printed guideline and patient brochures. Patient’s outcomes investigated: WOMAC pain and stiffness scores, body mass index and self-reported treatment received (oral NSAID, physical exercise, alternative treatment) at 6 and 12 months after the intervention. During statistical analysis clustering was taken into account, for the outcomes with significant baseline imbalance between the comparison groups the adjustment was made.
Results The mean adjusted WOMAC pain in the intervention group was 6,9 points lower at 6 month (p =0,16) and 13,3 points lower at 12 month (p =0,017) after the guideline implementation. The mean adjusted WOMAC stiffness was 6,7 points lower at 6 month (p =0,29) and 14,2 points lower (p =0,039) at 12 month. Proportion of the patients who use an alternative treatment decreased in the intervention group dramatically – by 23% at 6 month (p =0,044), and by 33% at 12 month (p =0,024). The rest of the changes in the intervention group were less conclusive: to the end of the year mean BMI slightly decreased (-1,4; p =0,86), adjusted regular NSAIDs usage decreased by 3% at 6 month (p =0,7), and then increased by 10% at 12 month (p =0,21). Adherence to the regular physical exercises was 13% higher at 6 month (p =0,23) and 9% higher at 12 month (p =0,42) in the intervention group.
Conclusions The implementation of the osteoarthritis clinical guideline by means of the didactic educational meeting in combination with dissemination of the printed guideline and patient brochures may optimize treatment and improve patient outcomes in a long term perspective, but the trials of a greater sample size are needed to confirm this effect more precisely.
Akesson K., Dreinhofer K.E., Woolf A.D. Improved education in musculoskeletal conditions is necessary for all doctors. Bulletin of the World Health Organization 2003;81(9):677–82.
Grimshaw J.M., Thomas R.E., MacLennanet G., Fraser C., Ramsay C.R., Vale L. et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004;8:1–352.
Disclosure of Interest None Declared
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