在初级保健中实施国际骨关节炎指南：卫生专业人员和患者的接受度和忠实度。
Implementing international osteoarthritis guidelines in primary care: uptake and fidelity among health professionals and patients.
机构信息
National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, N-0319, Oslo, Norway.
出版信息
Osteoarthritis Cartilage. 2019 Aug;27(8):1138-1147. doi: 10.1016/j.joca.2019.03.010. Epub 2019 May 8.
OBJECTIVE
This paper evaluates the implementation fidelity of a strategy and intervention used to implement osteoarthritis (OA) treatment recommendations in primary care. We also evaluate uptake of core treatment (patient information, exercise and referral to weight management) among OA patients.
DESIGN
A stepped-wedge cluster-randomised controlled study (RCT) in primary care. The study involved general practitioners (GPs), physiotherapists (PTs) and patients with hip and/or knee OA in six Norwegian municipalities (clusters). Workshops for general practitioners (GPs) and PTs represented the main implementation activity. Uptake of core treatment (patient education, exercise and weight management) was evaluated using self-reported data from the patient intervention and control group, analysed with logistic regression models. Fidelity was evaluated using six components representing adherence to the content and dose instructions in the implementation strategy and assessed against a-priori criteria for high adherence.
RESULTS
Data were collected from 40 GPs, 37 PTs and 393 OA patients. The patient-reported data showed statistically significant higher uptake for exercise, patient education and referral to support for weight reduction, among the intervention group compared to the control group (P < 0.05). Evaluation of fidelity showed high adherence to GP and PT workshop attendance and physiotherapy use, partly adherence to PT knowledge after workshops, and low adherence to exercise attendance, dose and progression instructions.
CONCLUSIONS
The implementation strategy and intervention successfully improved OA patients' access to physiotherapy and uptake of recommended core treatment. However, the strategy was less effective in providing exercise programs with sufficient dose and progression and in supporting patients' adherence to the exercise program.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02333656.
目的
本文评估了在初级保健中实施骨关节炎（OA）治疗建议所使用的策略和干预措施的实施保真度。我们还评估了 OA 患者接受核心治疗（患者信息、运动和转介至体重管理）的情况。
设计
在初级保健中进行的逐步楔形聚类随机对照研究（RCT）。该研究涉及挪威六个城市（集群）的全科医生（GP）、物理治疗师（PT）和髋部和/或膝部 OA 患者。GP 和 PT 的研讨会是主要的实施活动。通过患者干预组和对照组的自我报告数据评估核心治疗（患者教育、运动和体重管理）的采用情况，采用逻辑回归模型进行分析。保真度通过代表实施策略中内容和剂量说明的遵守情况的六个组件进行评估，并根据高遵守的预先设定标准进行评估。
结果
共收集了 40 名全科医生、37 名物理治疗师和 393 名 OA 患者的数据。与对照组相比，干预组患者报告的运动、患者教育和转介至支持减轻体重的治疗方法的采用率显著更高（P<0.05）。保真度评估显示，GP 和 PT 研讨会的出席率和物理治疗的使用率高，PT 知识在研讨会后的部分依从性高，而运动的出席率、剂量和进展说明的依从性低。
结论
实施策略和干预措施成功地增加了 OA 患者获得物理治疗和接受推荐核心治疗的机会。然而，该策略在提供足够剂量和进展的运动方案以及支持患者对运动方案的依从性方面效果较差。
试验注册
ClinicalTrials.gov NCT02333656。
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