Porcheret Mark, Main Chris, Croft Peter, Dziedzic Krysia
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.
BMC Fam Pract. 2018 Feb 6;19(1):26. doi: 10.1186/s12875-018-0715-8.
Professionally-focussed behaviour change intervention (BCI) workshops were utilised in the Management of OsteoArthritis in Consultations (MOSAICS) trial investigating the feasibility of implementing the National Institute for Health and Care Excellence (NICE) Osteoarthritis (OA) Guideline in general practice. The workshops aimed to implement the general practitioner (GP) component of the trial intervention: an enhanced consultation for patients presenting with possible OA. This study presents an evaluation of the BCI workshops on GP competency in conducting these enhanced consultations.
A before-and-after evaluation of the workshops, delivered to GPs participating in the intervention arm of the MOSAICS trial, using video-recorded GP consultations with simulated OA patients. GPs attended four workshops, which had been developed using an implementation framework. Videos were undertaken at three time-points (before workshops and at one- and five-months after) and were assessed by independent observers, blinded to time points, for GP competency in undertaking 14 predetermined consultation tasks.
Videos of 15 GPs were assessed. GP competency increased from a median of seven consultation tasks undertaken by each GP at baseline to 11 at both time-points after the workshops. Specific tasks which were undertaken more frequently after the workshops related to explaining that OA is treatable and not inevitably progressive, eliciting and addressing patient expectations of the consultation, and providing written OA information. However, the use of the word "osteoarthritis" in giving the diagnosis of OA was not enhanced by the workshops.
BCI workshops can enhance GP competency in undertaking consultations for OA. Further initiatives to implement the NICE OA Guideline and enhance the care of people with OA in primary care can be informed by the content and delivery of the workshops evaluated in this study.
以专业为重点的行为改变干预（BCI）研讨会被用于骨关节炎咨询管理（MOSAICS）试验，该试验旨在研究在全科医疗中实施英国国家卫生与临床优化研究所（NICE）骨关节炎（OA）指南的可行性。这些研讨会旨在实施试验干预措施中的全科医生（GP）部分：对可能患有OA的患者进行强化咨询。本研究对BCI研讨会在全科医生进行这些强化咨询的能力方面进行了评估。
对参加MOSAICS试验干预组的全科医生举办的研讨会进行前后评估，采用与模拟OA患者进行视频录制的全科医生咨询。全科医生参加了四个使用实施框架开发而成的研讨会。在三个时间点（研讨会前、研讨会后1个月和5个月）进行视频录制，并由对时间点不知情的独立观察员评估全科医生在执行14项预先确定的咨询任务方面的能力。
对15名全科医生的视频进行了评估。全科医生的能力从中位数来看，从基线时每位全科医生执行7项咨询任务增加到研讨会后的两个时间点的11项。研讨会后更频繁执行的具体任务包括解释OA是可治疗的且并非必然进展、引出并解决患者对咨询的期望以及提供书面OA信息。然而，研讨会并未提高在诊断OA时使用“骨关节炎”一词的频率。
BCI研讨会可提高全科医生进行OA咨询的能力。本研究评估的研讨会的内容和实施方式可为进一步实施NICE OA指南及改善初级医疗中OA患者护理的举措提供参考。
