Health professionals and students encounter multi-level barriers to implementing high-value osteoarthritis care: a multi-national study

Briggs, Andrew M.; Houlding, Elizabeth; Hinman, Rana S; Desmond, Lucy; Bennell, Kim L; Darlow, Ben; Pizzari, Tania; Leech, Michelle; MacKay, Crystal; Larmer, Peter; Bendrups, A.; Greig, Alison; Francis‐Cracknell, Alison; Jordan, Joanne E; Slater, Helen

doi:10.1016/j.joca.2018.12.024

Cited by 77 publications

(80 citation statements)

References 46 publications

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“…The survey collected data on demographics, employment (clinicians), and educational history (students) (). The items of the survey focusing on barriers and enablers to implementation of high‐value care have been reported previously , whereas the outcome measures and data reported here are unique.…”

Section: Methodsmentioning

confidence: 99%

“…This approach has been comprehensively described elsewhere . Briefly, this involved development of an inductively derived coding framework.…”

Section: Methodsmentioning

confidence: 99%

“…We also sought to explore the differences in these outcomes between disciplines and predict clinicians’ outcomes based on demographic profiles. A companion paper, reporting unique data, has been published previously .…”

Section: Introductionmentioning

confidence: 99%

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Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study

Briggs

Hinman

Darlow

et al. 2019

ACR Open Rheumatology

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Objective. To measure confidence and attitudes of the current and emerging interprofessional workforce concerning osteoarthritis (OA) care.Methods. Study design is a multinational (Australia, New Zealand, Canada) cross-sectional survey of clinicians (general practitioners [GPs], GP registrars, primary care nurses, and physiotherapists) and final-year medical and physiotherapy students. GPs and GP registrars were only sampled in Australia/New Zealand and Australia, respectively. The study outcomes are as follows: confidence in OA knowledge and skills (customized instrument), biomedical attitudes to care (Pain Attitudes Beliefs Scale [PABS]), attitudes toward high-and low-value care (customized items), attitudes toward exercise/physical activity (free-text responses).Results. A total of 1886 clinicians and 1161 students responded. Although a number of interprofessional differences were identified, confidence in OA knowledge and skills was consistently greatest among physiotherapists and lowest among nurses (eg, the mean difference [95% confidence interval (CI)] for physiotherapist-nurse analyses were 9.3 [7.7-10.9] for knowledge [scale: 11-55] and 14.6 [12.3-17.0] for skills [scale: 16-80]). Similarly, biomedical attitudes were stronger in nurses compared with physiotherapists (6.9 [5.3-8.4]; scale 10-60) and in medical students compared with physiotherapy students (2.0 [1.3-2.7]). Some clinicians and students agreed that people with OA will ultimately require total joint replacement (7%-19% and 19%-22%, respectively), that arthroscopy is an appropriate intervention for knee OA (18%-36% and 35%-44%), and that magnetic resonance imaging is informative for diagnosis and clinical management of hip/knee OA (8%-61% and 21%-52%). Most agreed (90%-98% and 92%-97%) that exercise is indicated and strongly supported by qualitative data.Conclusion. Workforce capacity building that de-emphasizes biomedical management and promotes high-value first-line care options is needed. Knowledge and skills among physiotherapists support leadership roles in OA care for this discipline.

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Section: Methodsmentioning

confidence: 99%

“…This approach has been comprehensively described elsewhere . Briefly, this involved development of an inductively derived coding framework.…”

Section: Methodsmentioning

confidence: 99%

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Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study

Briggs

Hinman

Darlow

et al. 2019

ACR Open Rheumatology

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“…Coaching from clinicians must be patient-centred and tailored to the needs and concerns of the individual [33]. Training and protocols for the clinicians are important intervention components, especially since these coaching skills are not often taught during entry to practice training for health professionals and both clinicians and trainees report skills deficits in this area [46]. In addition to being able to effectively deliver high quality information to facilitate desired behaviour change, clinicians also need to incorporate specific behaviour change techniques such as shared decision-making, goal setting, problem solving, confidence building, review and reinforcement.…”

Section: Intervention Designmentioning

confidence: 99%

Better Knee, Better Me™: effectiveness of two scalable health care interventions supporting self-management for knee osteoarthritis – protocol for a randomized controlled trial

Bennell

Keating²,

Lawford

et al. 2020

BMC Musculoskelet Disord

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Background: Although education, exercise, and weight loss are recommended for management of knee osteoarthritis, the additional benefits of incorporating weight loss strategies into exercise interventions have not been well investigated. The aim of this study is to compare, in a private health insurance setting, the clinical-and cost-effectiveness of a remotely-delivered, evidence-and theory-informed, behaviour change intervention targeting exercise and self-management (Exercise intervention), with the same intervention plus active weight management (Exercise plus weight management intervention), and with an information-only control group for people with knee osteoarthritis who are overweight or obese.

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“…Expert's free text responses were coded using an inductive approach as described in previous studies [34,35,36] wherein the content of the responses was used to develop a coding framework. Two independent coders (EH, NL) developed separate coding schema, and then discussed and settled disagreements by consensus.…”

Section: Qualitativementioning

confidence: 99%

Experts Prioritize Osteoarthritis Non-Surgical Interventions From Cochrane Systematic Reviews for Translation Into “Evidence4Equity” Summaries.

Houlding

Petkovic

Lebel

et al. 2020

Preprint

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Objective: Osteoarthritis carries substantial health and socioeconomic burden, which is particularly marked in marginalised groups. It is imperative that practitioners have ready access to summaries of evidence-based interventions for osteoarthritis that incorporate equity considerations. Summaries of systematic reviews can provide this. The present study surveyed experts to inform the selection of interventions to generate Cochrane Evidence4Equity (E4E) summaries. Methods: We identified 29 non-surgical interventions to prioritise. Key findings from these interventions were summarised and provided to 9 experts in the field of osteoarthritis. Expert participants were asked to rate interventions based on feasibility, health system effects, universality, impact on inequities, and priority for translation into equity based E4E summaries. Results: Expert participants rated land-based exercise highest for priority for translation into an E4E summaries. Conclusion: The survey generated information that can be used to direct and support knowledge translation efforts.

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Health professionals and students encounter multi-level barriers to implementing high-value osteoarthritis care: a multi-national study

Abstract: Conclusions: Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).

Cited by 77 publications

References 46 publications

Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study

Confidence and Attitudes Toward Osteoarthritis Care Among the Current and Emerging Health Workforce: A Multinational Interprofessional Study

Better Knee, Better Me™: effectiveness of two scalable health care interventions supporting self-management for knee osteoarthritis – protocol for a randomized controlled trial

Experts Prioritize Osteoarthritis Non-Surgical Interventions From Cochrane Systematic Reviews for Translation Into “Evidence4Equity” Summaries.

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