Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK; Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
Osteoarthritis Cartilage. 2017 Oct;25(10):1588-1597. doi: 10.1016/j.joca.2017.05.017. Epub 2017 Jun 4.
To determine the effect of a model osteoarthritis (OA) consultation (MOAC) informed by National Institute for Health and Care Excellence (NICE) recommendations compared with usual care on recorded quality of care of clinical OA in general practice.
Two-arm cluster randomised controlled trial.
Eight general practices in Cheshire, Shropshire, or Staffordshire UK.
General practitioners and nurses with patients consulting with clinical OA.
Following six-month baseline period practices were randomised to intervention (n = 4) or usual care (n = 4). Intervention practices delivered MOAC (enhanced initial GP consultation, nurse-led clinic, OA guidebook) to patients aged ≥45 years consulting with clinical OA. An electronic (e-)template for consultations was used in all practices to record OA quality care indicators.
Quality of OA care over six months recorded in the medical record.
1851 patients consulted in baseline period (1015 intervention; 836 control); 1960 consulted following randomisation (1118 intervention; 842 control). At baseline wide variations in quality of care were noted. Post-randomisation increases were found for written advice on OA (4-28%), exercise (4-22%) and weight loss (1-15%) in intervention practices but not controls (1-3%). Intervention practices were more likely to refer to physiotherapy (10% vs 2%, odds ratio 5.30; 95% CI 2.11, 13.34), and prescribe paracetamol (22% vs 14%, 1.74; 95% CI 1.27, 2.38).
The intervention did not improve all aspects of care but increased core NICE recommendations of written advice on OA, exercise and weight management. There remains a need to reduce variation and uniformly enhance improvement in recorded OA care.
ISRCTN06984617.
通过一项基于英国国家卫生与临床优化研究所（NICE）建议的骨关节炎（OA）模式咨询（MOAC）与常规护理相比，确定其对普通实践中记录的临床 OA 护理质量的影响。
双臂聚类随机对照试验。
英国柴郡、什罗普郡或斯塔福德郡的 8 家全科诊所。
具有临床 OA 就诊患者的全科医生和护士。
在六个月的基线期后，将实践随机分为干预组（n=4）或常规护理组（n=4）。干预组为年龄≥45 岁的临床 OA 就诊患者提供 MOAC（增强的初始 GP 咨询、护士主导的诊所、OA 指南）。所有实践都使用电子（e-）模板记录 OA 质量护理指标。
在基线期内有 1851 名患者就诊（干预组 1015 例，对照组 836 例）；随机分组后有 1960 名患者就诊（干预组 1118 例，对照组 842 例）。在基线期，护理质量存在广泛差异。在随机分组后，干预组的 OA 书面建议（4-28%）、运动（4-22%）和减肥（1-15%）增加，但对照组没有（1-3%）。干预组更有可能转介到物理治疗（10%对 2%，优势比 5.30；95%CI 2.11，13.34），并开具扑热息痛（22%对 14%，1.74；95%CI 1.27，2.38）。
该干预措施并未改善所有护理方面，但增加了 NICE 核心建议的 OA、运动和体重管理方面的书面建议。仍然需要减少差异，并统一提高 OA 护理的记录。
ISRCTN06984617。
