Implementing arthritis clinical practice guidelines in primary care

Abstract

Background: Multi-faceted interventions are among the strongest methods for changing provider behavior.

Aims: This paper reports the design, implementation and process evaluation of an educational program to disseminate clinical practice guidelines (CPGs) on the management of rheumatoid arthritis (RA) and osteoarthritis (OA) in primary care.

Methods: Organizations were invited to participate in inter-professional workshops on OA and RA followed by six months of activities to support the delivery of care in the community. Confidence in ability to manage arthritis was assessed at baseline using a 10 point numerical rating scale. Qualitative assessments were done immediately and 3–12 months post workshop.

Results: 646 multidisciplinary providers from 216 organizations attended one of 30 workshops. Providers (n = 584) reported moderate confidence in managing arthritis: family physicians: mean: SD = 7.46(1.42), n = 145; nurse practitioners: 6.10(1.84), n = 73; other health care professionals: 5.23(2.83), n = 389. Participants identified team learning, the opportunity to network and the involvement of trained patient educators as strong features of the workshops. At follow-up, participants indicated the greatest impact of the program was on collaborative care (83%) and patient self-management (79%).

Conclusions: Qualitative results suggest that inter-professional learning may be a successful strategy for improving the delivery of collaborative arthritis care and supporting patient self-management.

Additional information

Notes on contributors

Sydney C. Lineker

SYDNEY LINEKER was Director of the project and co-principal investigator on the Health Canada grant that funded this project. She was responsible for the overall administration of this national project and was a member of the evaluation team.

Mary J. Bell

MARY J. BELL, was co-principal investigator on this grant, Scientific Advisor to the project and member of the evaluation team and presented at several of the workshops. She was responsible for coordinating the involvement of the rheumatologists in this project and was the key link with the Canadian Rheumatology Association.

Jennifer Boyle

JENNIFER BOYLE managed all phases of the project evaluation including multiple ethics submissions, data entry, cleaning and analysis, supervision and training of students and other research staff involved in the project and dissemination of results through poster presentations and abstracts.

Elizabeth M. Badley

ELIZABETH M. BADLEY was a member of the Partners’ Group and responsible for the overall evaluation of this project. She provided scientific advice on all phases of the research including design of the evaluation of the pilot and national implementation (workshop evaluation, qualitative and quantitative evaluations).

Lois Flakstad

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.

John Fleming

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.

Anne Lyddiatt

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.

Jane MacDonald

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.

Jack McCarthy

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.

Michel Zummer

LOIS FLAKSTAD, JOHN FLEMING, ANNE LYDDIATT, JANE MACDONALD, JACK MCCARTHY, MICHEL ZUMMER, Members of the Getting a Grip on Arthritis© Partners' Group were involved in the design, implementation and evaluation of the project, engaged members of their organizations in the project as needed and disseminated results.