Recommendations for the best practices in OA care can be established by a combination of consensus of expert opinion (including lay participants), high quality original studies, systematic reviews, clinical guidelines, implementation strategies and quality indicators. Recommendations can focus on diagnosis, assessment, treatment and developing measures of OA care.
The European League Against Rheumatism has published a series of evidence-based guidelines for the management and the diagnosis of osteoarthritis (OA) at different joint sites. The first message that emerges from the guidelines is that there are a range of diagnostic approaches and interventions for which there is high quality evidence. The important question is, are they being adopted in clinical practice? The difficulty for the health care professional is to determine which ones should be employed.
There is increasing recognition that implementation of recommendations for the better diagnosis, assessment and management of OA is very different from simply disseminating information. The good news is that a multifaceted approach may offer a potential method of changing practice and ultimately improving OA care. The complexity of evaluating the impact of such initiatives and the difficulty of getting evidence into practice cannot be underestimated. Educational programs often result in only small changes in professional behaviour but lessons can be learnt on how to improve subsequent initiatives.
Our own group is studying how best to implement the NICE OA recommendations (1) and optimise the consultation for OA in UK primary care with patients, general practitioners, practice nurses and the broader multidisciplinary team. A whole systems approach is needed, which engages with practitioners and service organisations as well as the patient; the WISE model (“Whole system Informing Self-management Engagement”) (2). The WISE approach envisages informed patients receiving support and guidance from those trained practitioners who are working within a healthcare system which is geared up to be responsive to patients’ needs. To evaluate this approach we have adopted the toolkit (http://www.normalizationprocess.org/) proposed by the Normalisation Process Theory (3).
This presentation will give an overview of the mechanisms by which best OA care can be implemented in the real world using UK primary care as an example.
NICES. Osteoarthritis: national clinical guideline for care and management in adults, National Institute for Health and Clinical Excellence, 2008. www.nice.org.uk/CG59
Kennedy AP, Rogers AE, Bower P, Support for self care for patients with chronic disease BMJ 2007;335:968-970
May C, Finch T. Implementing, embedding and integrating practices: an outline of Normalisation Process Theory. Sociology 2009;43:535-554.
Disclosure of Interest None Declared