Background A national guideline for the management of osteoarthritis (OA) in primary care was published in the UK by the National Institute for Health and Clinical Excellence (NICE) in 2008. Consensus work has developed a model OA consultation1 to implement the NICE guidelines in a consultation between a general practitioner (GP) and a patient with peripheral joint pain. In a study to investigate the acceptability and potential effect of the model OA consultation (MOSAICS) GPs were trained to deliver the model OA consultation in day-to-day practice and were video recorded consulting with simulated OA patients before and after study training.
Objectives To develop and test the reliability of criteria to rate the extent to which video recorded consultations for OA captured the essential features of the model OA consultation.
Methods The draft rating criteria were based on the key elements of the model OA consultation which could be observed on a video recording. The criteria were refined by a panel of four reviewers (academic GP, pain specialist, physiotherapist, epidemiologist) using two training videos on the model OA consultation. Gold standard ratings – criteria present or absent - were then produced by the panel for five different videos of study GPs before and after training. Four other GPs were trained to rate video recorded consultations using the final criteria and then individually rated the five videos, which were presented to them in random order. For each rater, percentage agreement, and sensitivity and specificity compared with the gold standard ratings were determined. Ethical permission was obtained from South Manchester Research Ethics Committee.
Results The final criteria consisted of 14 observable behaviours which covered six aspects of the consultation: giving the diagnosis, explaining the diagnosis, addressing expectations, providing analgesia, promoting self-management and providing self-management support. Raters were able to rate all the criteria for all five videos. The percentage agreement with the gold standard for the four raters ranged from 80% to 86%. The sensitivity (proportion of criteria rated present if gold standard rated present) ranged from 85% to 98% and specificity (proportion rated absent if gold standard absent) ranged from 46% to 83%.
Conclusions There was good overall agreement between the raters and the gold standard. Raters were good at identifying elements of the model consultation which had taken place (based on the gold standard rating). There was more variation in identifying when elements had not taken place. Further training will be undertaken with the raters to improve the specificity of the criteria.
Porcheret M, Grime J, Main C, Dziedzic K. Developing a model osteoarthritis consultation: a Delphi consensus exercise. BMC Musculoskeletal Disorders 2013, 14:25 doi:10.1186/1471-2474-14-2
Acknowledgements We would like to thank all the GPs in the study practices for agreeing to be video’d, Drs Claire Burton, John Edwards, Richard Haywood and Simon Somerville for undertaking the rating, and the MOSAICS team, especially Angela Pushpa-Rajah, Chan Vohora and Debbie D’Cruz, for organising and co-ordinating the recordings.
Disclosure of Interest None Declared
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