MUSCULOSKELETAL MATTERS – BULLETIN 9
An electronic template for osteoarthritis consultations
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Primary care of osteoarthritis( OA) is not consistent with national and international guidance
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Structured computerised forms( templates) to complete during a consultation improve some aspects of clinical care including adherence to some processes of care
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GPs and practice nurses are used to such templates as part of their routine consultation recording
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We implemented a new template to guide and record consultations for OA
Fig. 1 EMIS Web template example
‘ GPs emphasised how using the template fitted with their existing work patterns, made them more pro-active, and alerted them to checking on pain relief. This was presented as“ I just do a bit more than I used to”’ 2
The evaluation of the template was positive. Approximately two-thirds of patients with OA or joint pain had at least one template entry completed.
There was substantial variation between clinicians. A quarter completed at least one entry for 9 out of 10 patients but another quarter did not record any entry for more than half of their patients. Introduction of the template was associated with a significant increase in:
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Weight recording
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Prescription of NICE-approved first line analgesia e. g. topical NSAIDS 1
The template was triggered by a wide range of OA and joint pain codes considered by a panel of 6 GPs to represent possible underlying OA. It sought to capture aspects of assessment and care not uniformly well-captured by the standard electronic record, including 1:
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Pain and function assessments
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NICE guideline core interventions of information provision, exercise advice, and weight loss advice
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Physiotherapy use
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First-line analgesic use— paracetamol and topical non-steroidal antiinflammatories( NSAIDs)
‘ In conclusion, the template was welcomed by the GPs in helping them to be more systematic in assessing a patient’ s needs.’ 2
Key messages for clinicians
• OA care needs to be improved
• Non-pharmacological interventions still need to be better-promoted
• Templates can assist with information capture and processes of care
• Templates are feasible to integrate into routine working patterns
Key messages for commissioners
• Better care for OA in general practice is achievable given appropriate multidisciplinary support
• Non-pharmacological core treatments of education, exercise, and weight loss may require additional resources
References
1. Edwards, J. J., Jordan, K. P., Peat, G., Bedson, J., Croft, P. R., Hay, E. M., et al. Quality of care for OA: the effect of a point-of-care consultation recording template. Rheumatology 2014 doi: 10.1093 / rheumatology / keu411
2. Ong, B. N., Morden, A., Brooks, L., Porcheret, M., Edwards, J. J., Sanders, T. et al. Changing policy and practice: making sense of national guidelines for osteoarthritis. Soc Sci Med 2014; 106:101-09 doi: 10.1016 / j. socscimed. 2014.01.036
This is a summary of independent research arising from an In-Practice Fellowship funded by the National Institute for Health Research( NIHR)( Grant ref. IAT / I- PF / 010 / 009) as well as funding from the NIHR Programme Grants for Applied Research Programme( Grant Ref. RP-PG-0407-10386). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
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