Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow Jrheum on BlueSky
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
EditorialEditorial

Uptake of Best Arthritis Practice in Primary Care — No Quick Fixes

MARK PORCHERET, EMMA HEALEY and KRYSIA S. DZIEDZIC
The Journal of Rheumatology May 2011, 38 (5) 791-793; DOI: https://doi.org/10.3899/jrheum.110093
MARK PORCHERET
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
EMMA HEALEY
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
KRYSIA S. DZIEDZIC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: k.s.dziedzic@keele.ac.uk
  • Article
  • Info & Metrics
  • References
  • PDF
PreviousNext
Loading

Arthritis is one of the most common chronic conditions and is a leading cause of pain, physical disability, and use of healthcare resources1. The Canadian Community Health Survey conducted in 2000 demonstrated that arthritis and other rheumatic conditions affect nearly 4 million Canadians aged 15 years and older2. By 2026, it has been estimated that this figure will rise to over 6 million Canadians.

In the UK the National Institute for Health and Clinical Excellence developed recommendations for the management of rheumatoid arthritis3 and osteoarthritis (OA)4,5. For primary care the first message that emerges from the reviews and guidelines, particularly for OA, is that there is a range of simple interventions for which there is evidence of efficacy. By contrast, evidence that these same interventions are being systematically and widely put into practice, and evidence about how to do this, is singularly lacking6,7,8. There is increasing recognition that implementation of change for the better management of arthritis is very different from simply disseminating information9,10.

Despite many published treatment guidelines there is often a gap between the care that is recommended and the care that such patients receive11; therefore numerous studies have demonstrated the need for improved arthritis management within primary care12,13. Unfortunately, their abundance can often make it difficult for healthcare professionals to determine which guidelines should be employed within clinical practice14. It has been shown that passive distribution of guidelines has limited impact15, and evidence of the implementation of health education interventions aiming to increase the uptake of arthritis guidelines in primary care is scarce16.

Lineker, et al17 suggested that the dissemination of treatment guidelines through a multifaceted intervention may be a method of changing provider behavior and thus improving arthritis management. As a result, the Getting a Grip on Arthritis® education program developed by Glazier, et al18, which consists of an accredited interprofessional workshop and 6 months of reinforcement activities, aims to improve the diagnosis and treatment of arthritis in primary care in Canada.

The extensive work undertaken in the development and evaluation of this intervention, including surveys with primary care practitioners and qualitative work17,19,20, is impressive. Pilot work of the intervention demonstrated clear changes in the management of arthritis in primary care18, and as a result the program received funding for national implementation through Health Canada’s Primary Health Care Transition Fund.

In this issue of The Journal, Lineker, et al21 describe the evaluation of the national rollout of the Getting a Grip on Arthritis® program. In all, 553 primary healthcare professionals (30.9% nurses, 22.5% rehabilitation professionals, 22.5% physicians, 10.9% nurse practitioners, 13.1% other healthcare providers/nonclinical staff/students) from 254 sites took part. The influence of the program was evaluated by a previously validated survey to highlight self-report management of 3 case scenarios, with best-practice scores (number of recommended best practices a participant would undertake) calculated for each scenario at baseline and 6 months post-workshop. This survey also assessed perception of barriers to physiotherapy, occupational therapy, social work or rheumatology, confidence in the management of arthritis, and satisfaction with their ability to deliver arthritis care.

About one-half completed the followup survey. Overall best-practice scores improved for all scenarios at 6 months, but an analysis by discipline showed that only nurse practitioners and rehabilitation therapists (occupational therapists and physiotherapists) achieved a clinically significant improvement. Baseline scores were low for all 3 scenarios, with the best post-training score being achieved by nurse practitioners for the management of OA. Many best practices did not show any increase, but there was a noticeable increase in the recommendations for education for all scenarios, and weight management for OA. The latter (a notoriously difficult topic to address) more than tripled, although from a very low base. With regard to satisfaction and confidence, both improved significantly at 6 months, and perception of barriers to all services decreased significantly.

The authors acknowledge that the study had a number of limitations: there was no control group, there was a low response to the followup survey, and self-report behavior is an uncertain proxy measure of actual practice. So the improvements seen in this study may not have been due to the program or may not have been seen in all participants, nor followed through into day-to-day practice. However, the article illustrates the complexity of evaluating the effect of such initiatives and the difficulty of getting evidence into practice. Such educational programs often result in only small changes in professional behavior22, but the rigorous approach taken to the delivery and evaluation of this program ensures that lessons can be learned on how to improve subsequent initiatives. The authors conclude that such interprofessional education may be an effective method for improving the uptake of clinical guidelines, with potential to improve the management of arthritis in primary care.

Similar initiatives are being developed elsewhere. For example, in the UK the National Institute of Health and Clinical Research (NIHR) has funded a number of research initiatives to study the implementation of guidelines into primary care. This work is also supported by the leading arthritis charity in the UK, the Arthritis Research UK, and patient groups like Arthritis Care.

Our own group is studying how best to implement the National Institute for Health and Clinical Excellence (NICE) OA recommendations and optimize the consultation for OA in primary care with patients, general practitioners, practice nurses, and the broader multidisciplinary team. A whole-systems approach is needed, which engages with practitioners and service organizations as well as the patient. Similar to the Canadian approach, we have identified suitable models and theories to develop such training and implementation strategies, including the WISE model (“Whole system Informing Self-management Engagement”)23, implementation theory24, and behavior change theories25,26. A whole-systems approach envisages informed patients receiving support and guidance from those trained practitioners who are working within a healthcare system geared up to be responsive to patients’ needs23. To evaluate this approach we have adopted the toolkit (http://www.normalizationprocess.org/) proposed by the Normalisation Process Theory27,28 — a medium-range sociological theory concerned with understanding how complex interventions become embedded in routine clinical practice.

The Canadian model represents a major contribution to the mechanism by which evidence-based practice can be implemented in the real world. It highlights the complexities and challenges of delivering training to health professionals in order to change the way in which they consult with individuals with rheumatoid arthritis and OA, and in turn to support individuals in the uptake of best care.

The model is attractive because of its widespread adoption and influence; and while its limitations are acknowledged, the complexities of such research cannot be overlooked. We have much to learn from this work.

REFERENCES

  1. 1.↵
    1. Girard F,
    2. Guillemin F,
    3. Novella JL,
    4. Valckenaere I,
    5. Krzanowska K,
    6. Vitry F,
    7. et al.
    Health-care use by rheumatoid arthritis patients compared with non-arthritic subjects. Rheumatology 2002;41:167–75.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Statistics Canada
    . Canadian Community Health Survey (CCHS), Cycle 1.1, derived variable (DV) specifications. Ottawa, Ontario: Statistics Canada, Health Statistics Division; 2002.
  3. 3.↵
    1. National Institute for Health and Clinical Excellence
    . Rheumatoid arthritis: the management of rheumatoid arthritis in adults. London: National Institute for Health and Clinical Excellence; 2009. [Internet. Accessed February 25, 2011.] Available from: www.nice.org.uk/CG79
  4. 4.↵
    1. National Institute for Health and Clinical Excellence
    . Osteoarthritis: national clinical guideline for care and management in adults. London: National Institute for Health and Clinical Excellence; 2008. [Internet. Accessed February 25, 2011.] Available from: www.nice.org.uk/CG59
  5. 5.↵
    1. Conaghan PG,
    2. Dickson J,
    3. Grant RL
    . Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ 2008;336:502–3.
    OpenUrlFREE Full Text
  6. 6.↵
    1. Peat G,
    2. Croft P,
    3. Hay E
    . Clinical assessment of the osteoarthritis patient. Best Pract Res Clin Rheumatol 2001;15:527–44.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Porcheret M,
    2. Jordan K,
    3. Jinks C,
    4. with the Primary Care Rheumatology Society
    . Primary care treatment of knee pain: a survey in older adults. Rheumatology 2007;46:1694–700.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Dziedzic KS,
    2. Hill JC,
    3. Porcheret M,
    4. Croft PR
    . New models for primary care are needed for osteoarthritis. Phys Ther 2009;89:1371–8.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Dieppe P,
    2. Doherty M
    . Contextualizing osteoarthritis care and the reasons for the gap between evidence and practice [review]. Clin Geriatr Med 2010;26:419–31.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Hunter DJ
    . Quality of osteoarthritis care for community-dwelling older adults [review]. Clin Geriatr Med 2010;26:401–17.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Steel N,
    2. Bachmann M,
    3. Maisey S,
    4. Shekelle P,
    5. Breeze E,
    6. Marmot M,
    7. et al.
    Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England. BMJ 2008;337:a957.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Williams JL,
    2. Badley EM
    1. Glazier RH
    . The role of primary care physicians in treating arthritis. In: Williams JL, Badley EM, editors. Arthritis and related conditions: an ICES practice atlas. Toronto: Institute for Clinical Evaluative Sciences; 1998:63–92.
  13. 13.↵
    1. Jawad AS
    . Analgesics and osteoarthritis: Are treatment guidelines reflected in clinical practice? Am J Ther 2005;12:98–103.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Rosser WW,
    2. Davis D,
    3. Gilbart E
    . Assessing guidelines for use in family practice. J Fam Pract 2001;50:974–5.
    OpenUrlPubMed
  15. 15.↵
    1. Grol R,
    2. Grimshaw J
    . From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003;362:1225–30.
    OpenUrlCrossRefPubMed
  16. 16.↵
    1. Lineker SC,
    2. Husted JA
    . Educational interventions for implementation of arthritis clinical practice guidelines in primary care: Effects on health professional behavior. J Rheumatol 2010;37:1562–9.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Lineker SC,
    2. Bell MJ,
    3. Boyle J,
    4. Badley EM,
    5. Flakstad L,
    6. Fleming J,
    7. et al.
    Implementing arthritis clinical practice guidelines in primary care. Medical Teacher 2009;32:230–7.
    OpenUrl
  18. 18.↵
    1. Glazier RH,
    2. Badley EM,
    3. Lineker SC,
    4. Wilkins AL,
    5. Bell MJ
    . Getting a grip on arthritis: an educational intervention for the diagnosis and treatment of arthritis in primary care. J Rheumatol 2005;31:137–42.
    OpenUrl
  19. 19.↵
    1. Glazier RH,
    2. Dalby DM,
    3. Badley EM,
    4. Hawker GA,
    5. Bell MJ,
    6. Buchbinder R,
    7. et al.
    Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians. Can Med Assoc J 1996;155:679–87.
    OpenUrlAbstract
  20. 20.↵
    1. Glazier RH,
    2. Dalby DM,
    3. Badley EM,
    4. Hawker GA,
    5. Bell MJ,
    6. Buchbinder R,
    7. et al.
    Management of common musculoskeletal problems: a survey of Ontario primary care physicians. Can Med Assoc J 1998;158:1037–40.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    1. Lineker SC,
    2. Bell MJ,
    3. Badley EM
    . Evaluation of an inter-professional educational intervention to improve the use of arthritis best practices in primary care. J Rheumatol 2011;38: 931–7.
    OpenUrlAbstract/FREE Full Text
  22. 22.↵
    1. Forsetlund L,
    2. Bjørndal A,
    3. Rashidian A,
    4. Jamtvedt G,
    5. O’Brien MA,
    6. Wolf F,
    7. et al.
    Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009;2:CD003030.
    OpenUrlPubMed
  23. 23.↵
    1. Kennedy AP,
    2. Rogers AE,
    3. Bower P
    . Support for self care for patients with chronic disease. BMJ 2007;335:968–70.
    OpenUrlFREE Full Text
  24. 24.↵
    1. Grol R,
    2. Wensing M,
    3. Eccles M
    . Improving patient care — The implementation of change in clinical practice. London: Elsevier; 2004.
  25. 25.↵
    1. Michie S,
    2. Johnston M,
    3. Abraham C,
    4. Lawton R,
    5. Parker D,
    6. Walker A,
    7. Psychological Theory Group
    . Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005;14:26–33.
    OpenUrlAbstract/FREE Full Text
  26. 26.↵
    1. Michie S,
    2. Johnston M,
    3. Francis J,
    4. Hardeman W,
    5. Eccles M
    . From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 2008;57:660–80.
    OpenUrlCrossRef
  27. 27.↵
    1. May T
    . Social research: Issues, methods and process. Buckingham: Open University Press; 1993.
  28. 28.↵
    1. May C,
    2. Finch T
    . Implementing, embedding and integrating practices: an outline of Normalisation Process Theory. Sociology 2009;43:535–54.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 38, Issue 5
1 May 2011
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Uptake of Best Arthritis Practice in Primary Care — No Quick Fixes
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Uptake of Best Arthritis Practice in Primary Care — No Quick Fixes
MARK PORCHERET, EMMA HEALEY, KRYSIA S. DZIEDZIC
The Journal of Rheumatology May 2011, 38 (5) 791-793; DOI: 10.3899/jrheum.110093

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Uptake of Best Arthritis Practice in Primary Care — No Quick Fixes
MARK PORCHERET, EMMA HEALEY, KRYSIA S. DZIEDZIC
The Journal of Rheumatology May 2011, 38 (5) 791-793; DOI: 10.3899/jrheum.110093
del.icio.us logo Twitter logo Facebook logo  logo Mendeley logo
  • Tweet Widget
  •  logo
Bookmark this article

Jump to section

  • Article
    • REFERENCES
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Reversing the Tide of the Growing Burden of Avoidable Musculoskeletal Pain and Disability
  • Interferon Response Gene Score in Juvenile Dermatomyositis
  • Revisiting Magnetic Resonance Imaging Structural Lesions in the Sacroiliac Joints
Show more Editorial

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2025 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire