MUSCULOSKELETAL MATTERS – BULLETIN 9
An electronic template for osteoarthritis consultations
◊◊
Primary care of osteoarthritis ( OA ) is not consistent with national and international guidance
◊◊
Structured computerised forms ( templates ) to complete during a consultation improve some aspects of clinical care including adherence to some processes of care
◊◊
GPs and practice nurses are used to such templates as part of their routine consultation recording
◊◊
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 :
◊◊
Weight recording
◊◊
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 :
◊◊
Pain and function assessments
◊◊
NICE guideline core interventions of information provision , exercise advice , and weight loss advice
◊◊
Physiotherapy use
◊◊
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 .
These Bulletins are designed to provide information for general practitioners , the primary care team , teachers , trainers and policy makers about musculoskeletal problems in practice .
For more information on these bulletins please visit : www . keele . ac . uk / pchs / disseminatingourresearch / newslettersandresources / bulletins