Babatunde Opeyemi O, Adetunji Oladapo, Alonge Ibidunni, Owoyemi Tolulope, Ayinmode Ebunoluwa, Ogunbanjo Adebimpe, White Simon, Adebajo Adewale Adebajo, Mallen Christian, Dziedzic Krysia
School of Medicine, Keele University Faculty of Health, Keele, UK
West African Institute for Applied Health Research, Ibadan, Nigeria.
BMJ Glob Health. 2025 Jun 19;10(6):e018714. doi: 10.1136/bmjgh-2024-018714.
OBJECTIVES: To assess the feasibility of a guideline-informed model of care for osteoarthritis in primary healthcare and community pharmacy settings in the West African context. METHODS: The 4-phase mixed-methods programme of research undertaken in Southwest Nigeria, West Africa. Phases 1-2 involved contextual adaptation of guideline-informed careJoint Implementation of Guidelines for OSteoArthritis in West-Africa (JIGSAW-A): (1) focus groups (n=4) with patients, community pharmacists and healthcare professionals (HCPs) to identify patient preferences and support needs of HCPs; (2) stakeholders resource contextualisation/codesign (ie, osteoarthritis guidebook in local languages, HCPs training/support package). Iterative codesign workshops (n=3) using participatory approaches, model osteoarthritis consultation simulations and consensus agreement.Phase 3: following training and a 12-week pilot implementation period, patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (modified 9-item scale 0%-100%, 100%=best), and implementation of the JIGSAW-A model of care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Patient and HCP interviews explored barriers and facilitators, usefulness and acceptability. In phase 4, recommendations for further scale-up and wider implementation of integrated osteoarthritis care were specified. RESULTS: Phases 1-2 highlight the burden and impact of everyday living with joint pain and misinformation which affects help-seeking. Participants expressed the need for a broad information and education campaign and access to self-management support, which informed iterative contextualisation of osteoarthritis care and patient information resources used to support pilot implementation in phase 3.Over 12 weeks, 12 HCPs (community pharmacies, physiotherapists and doctors) were involved in evaluation across nine sites. Of 369 patient consultations that were reported, high rates of quality indicator achievement were found for self-management advice (97%), topical analgesic use (89%) and exercise recommendations (87%). Compliance with full patient assessment in line with the protocol was poor (17%). CONCLUSIONS: We found that evidence-based care for osteoarthritis, involving community pharmacies (as a usual first point of call) and other primary care clinicians, is feasible and may improve aspects of care in low-resource settings. Further research is needed to ascertain long-term sustainability and cost-effectiveness.
目的:评估在西非背景下,以指南为依据的骨关节炎护理模式在初级医疗保健和社区药房环境中的可行性。 方法:在西非尼日利亚西南部开展了为期4个阶段的混合方法研究项目。第1 - 2阶段涉及对以指南为依据的护理进行情境调整——西非骨关节炎指南联合实施项目(JIGSAW - A):(1)与患者、社区药剂师和医疗保健专业人员(HCPs)进行焦点小组讨论(n = 4),以确定患者偏好和HCPs的支持需求;(2)利益相关者资源情境化/共同设计(即当地语言的骨关节炎指南手册、HCPs培训/支持包)。采用参与式方法、骨关节炎咨询模拟模型和共识协议进行迭代式共同设计研讨会(n = 3)。第3阶段:在培训和为期12周的试点实施期之后,通过骨关节炎质量指标问卷(修改后的9项量表,0% - 100%,100%为最佳)评估患者报告的护理质量,并使用可及性 - 有效性 - 采用 - 实施 - 维持框架评估JIGSAW - A护理模式的实施情况。通过患者和HCP访谈探讨障碍和促进因素、有用性和可接受性。在第4阶段,明确了进一步扩大规模和更广泛实施综合骨关节炎护理的建议。 结果:第1 - 2阶段突出了关节疼痛和错误信息对日常生活的负担和影响,这会影响患者寻求帮助。参与者表示需要开展广泛的信息和教育活动,并获得自我管理支持,这为骨关节炎护理和用于支持第3阶段试点实施的患者信息资源的迭代情境化提供了依据。在12周内,1名HCPs(社区药房、物理治疗师和医生)参与了9个地点的评估。在报告的369次患者咨询中,自我管理建议(97%)、局部镇痛药使用(89%)和运动建议(87%)的质量指标达成率较高。符合方案进行全面患者评估的情况较差(17%)。 结论:我们发现,涉及社区药房(通常作为第一求助点)和其他初级保健临床医生的基于证据的骨关节炎护理在资源匮乏地区是可行的,并且可能改善护理的各个方面。需要进一步研究以确定其长期可持续性和成本效益。
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