General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care

Abstract

Background Osteoarthritis (OA) is diagnosed and managed primarily by general practitioners (GPs). OA guidelines recommend using clinical criteria, without x-ray, for diagnosis, and advising strengthening exercise, aerobic activity and, if appropriate, weight loss as first-line treatments. These recommendations are often not implemented by GPs. To facilitate GP uptake of guidelines, greater understanding of GP practice behaviour is required. This qualitative study identified key factors influencing implementation of these recommendations in the primary-care setting. Methods Semi-structured interviews with eleven GPs were conducted, transcribed verbatim, coded by two independent researchers and analysed with an interpretive thematic approach using the COM-B model (Capability/Opportunity/Motivation-Behaviour) as a framework. Results Eleven themes were identified. Psychological capability themes: knowledge gaps, confidence to effectively manage OA, and skills to facilitate lifestyle change. Physical opportunity themes: system-related factors including time limitations, and patient resources. Social opportunity theme: influences from patients. Reflective motivation themes: GP’s perceived role, and assumptions about people with knee OA. Automatic motivation themes: optimism, habit, and unease discussing weight. The findings demonstrated diverse and interacting influences on GPs’ practice. Conclusion The identified themes provide insight into potential interventions to improve OA management in primary-care settings. Key suggestions include: improvements to OA clinical guidelines; targeting GP education to focus on identified knowledge gaps, confidence, and communication skills; development and implementation of new models of service delivery; and utilising positive social influences to facilitate best-practice behaviours. Complex, multimodal interventions that address multiple factors (both barriers and facilitators) are likely to be necessary.

‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain

“…These ‘failed treatments’ reinforced the belief among some participants that the damage to their hip structures was irreversible and that a hip replacement was inevitable. The belief that a joint replacement is the only definitive ‘cure’ for painful joints is common among older people with lower limb osteoarthritis and HCPs and may underlie low referral rates and low adherence to effective non-surgical management options 36–38. The repeated experience of ‘failed’ treatments has been suggested to play a role in symptom incoherence (an inability to make sense of pain) and the development of pain-related fear in people with musculoskeletal pain 33…”

Effectiveness of Health-Led Cognitive Behavioral-Based Group Therapy on Pain, Functional Disability and Psychological Outcomes among Knee Osteoarthritis Patients in Malaysia

“…Both are important elements in rehabilitating patients to enable ease in functions of daily living. However, we believe that these traits require frequent practice in certain activities to enable patients to regain confidence and overcome their fear avoidance beliefs [53]. Besides, the fact that the intervention program module in the present study includes only a six-minute walk test, rather than incorporating other physical performance tests including stair climb, lifting carrying task, standing balance and chair stands, might partly explain the non-significant findings in fear-avoidance beliefs.…”

PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

“…We also incorporated relevant 'quality indicators'. [26][27][28] We also gathered evidence of existing models of OA care delivery and initiatives from Australia and internationally, plus empirical research on alternative methods of delivering core components of knee OA care. Existing models were identified through literature searching and personal contacts.…”