Quality of Care for OA
Quality of Care for OA
Objective The aims of this study were to determine the feasibility of introducing a computerized template for identifying quality of care during an OA consultation, describe quality of OA care in practices in which the template was introduced and assess the effect of the template on routinely recorded clinician behaviour in those practices.
Methods A computerized template to assist the recording of care in consultations for patients with OA was installed in eight general practices. Eligible patients were those ≥45 years of age consulting for clinical OA during a 6 month period. The main outcomes were frequency of template triggering, achievement of quality indicators during the consultation (assessment of pain and function, assessment for first-line analgesics, provision of information, exercise advice, consideration of physiotherapy referral, weight loss advice) and change in routinely recorded clinician behaviour (diagnostic coding, prescribing, referral, use of radiography, weight records) compared with the 12 months prior to template installation.
Results The template was triggered for 1730 patients. Achievement of indicators ranged from 36% (for consideration of physiotherapy referral) to 63% (for pain assessment), with substantial variability between clinicians. There was an increase in prescription of recommended first-line analgesics following the template installation: paracetamol [odds ratio (OR) 1.49 (95% CI 1.22, 1.82) compared with pre-template] and topical NSAIDs [OR 1.95 (95% CI 1.61, 2.35)].
Conclusion This new template is a feasible tool for capturing data during OA consultations to aid assessment of quality of care. It was associated with significant improvements in recommended care processes. However, strategies are needed to ensure consistent approaches between clinicians.
OA is a leading cause of disability: the Global Burden of Disease 2010 ranked OA 11th in the global causes of years lived with disability. A recent review of the UK's health performance concluded that 'interventions are available for musculoskeletal disorders, but to what extent the health system is delivering is unclear'. Guidelines recommend a range of evidence-based treatment options for OA, and yet European and other surveys have demonstrated suboptimal management compared with guideline recommendations, including underuse of non-pharmacological measures, including exercise and weight loss, and suboptimal pharmacological management. Most health care contacts for OA occur within primary care. In the UK, 4% of adults aged ≥45 years consult for diagnosed OA each year, with the prevalence rising with age. This equates to more than a million people in the UK consulting primary care for OA in a year, and 8.75 million people in the UK have sought treatment for OA. Although there are no agreed benchmarks for performance, there is a recognized need to improve many aspects of primary care for OA.
Quality of care in general practice is generally assessed using process of care measures. For OA, these could relate to patient assessment, investigation, information provision, pharmacological and non-pharmacological management and referral. The indicators most feasibly implemented depend on prescribing data, which in the UK is generally electronically recorded and easily audited. There are difficulties with routine use of other potential indicators due to problems with identification of those receiving the care process (numerator) and those eligible for such care (denominator). For example, the need for and use of investigations and referral are not consistently well-captured by the primary care electronic record.
Computerized templates or point-of-care reminders have been shown to have small to moderate effects in improving the quality of consultations. This may be due partly to better recording, but it has also been attributed to improved processes of care. A trend has been identified toward greater effects for reminders that require an active response from the clinician. Oliver described a template for the multidisciplinary assessment of OA and RA, though there is a lack of evidence to describe the implementation and effect of computer templates in the management of OA.
The objectives of this study were, through a novel implementation of some of the principles of computerized templates, to determine the feasibility of introducing such a template for identification of quality of care during an OA consultation, describe quality of care for OA consultations in practices in which the template was introduced and assess the effect of the template on clinician behaviour, including pharmacological and some non-pharmacological aspects of management.
Abstract and Introduction
Abstract
Objective The aims of this study were to determine the feasibility of introducing a computerized template for identifying quality of care during an OA consultation, describe quality of OA care in practices in which the template was introduced and assess the effect of the template on routinely recorded clinician behaviour in those practices.
Methods A computerized template to assist the recording of care in consultations for patients with OA was installed in eight general practices. Eligible patients were those ≥45 years of age consulting for clinical OA during a 6 month period. The main outcomes were frequency of template triggering, achievement of quality indicators during the consultation (assessment of pain and function, assessment for first-line analgesics, provision of information, exercise advice, consideration of physiotherapy referral, weight loss advice) and change in routinely recorded clinician behaviour (diagnostic coding, prescribing, referral, use of radiography, weight records) compared with the 12 months prior to template installation.
Results The template was triggered for 1730 patients. Achievement of indicators ranged from 36% (for consideration of physiotherapy referral) to 63% (for pain assessment), with substantial variability between clinicians. There was an increase in prescription of recommended first-line analgesics following the template installation: paracetamol [odds ratio (OR) 1.49 (95% CI 1.22, 1.82) compared with pre-template] and topical NSAIDs [OR 1.95 (95% CI 1.61, 2.35)].
Conclusion This new template is a feasible tool for capturing data during OA consultations to aid assessment of quality of care. It was associated with significant improvements in recommended care processes. However, strategies are needed to ensure consistent approaches between clinicians.
Introduction
OA is a leading cause of disability: the Global Burden of Disease 2010 ranked OA 11th in the global causes of years lived with disability. A recent review of the UK's health performance concluded that 'interventions are available for musculoskeletal disorders, but to what extent the health system is delivering is unclear'. Guidelines recommend a range of evidence-based treatment options for OA, and yet European and other surveys have demonstrated suboptimal management compared with guideline recommendations, including underuse of non-pharmacological measures, including exercise and weight loss, and suboptimal pharmacological management. Most health care contacts for OA occur within primary care. In the UK, 4% of adults aged ≥45 years consult for diagnosed OA each year, with the prevalence rising with age. This equates to more than a million people in the UK consulting primary care for OA in a year, and 8.75 million people in the UK have sought treatment for OA. Although there are no agreed benchmarks for performance, there is a recognized need to improve many aspects of primary care for OA.
Quality of care in general practice is generally assessed using process of care measures. For OA, these could relate to patient assessment, investigation, information provision, pharmacological and non-pharmacological management and referral. The indicators most feasibly implemented depend on prescribing data, which in the UK is generally electronically recorded and easily audited. There are difficulties with routine use of other potential indicators due to problems with identification of those receiving the care process (numerator) and those eligible for such care (denominator). For example, the need for and use of investigations and referral are not consistently well-captured by the primary care electronic record.
Computerized templates or point-of-care reminders have been shown to have small to moderate effects in improving the quality of consultations. This may be due partly to better recording, but it has also been attributed to improved processes of care. A trend has been identified toward greater effects for reminders that require an active response from the clinician. Oliver described a template for the multidisciplinary assessment of OA and RA, though there is a lack of evidence to describe the implementation and effect of computer templates in the management of OA.
The objectives of this study were, through a novel implementation of some of the principles of computerized templates, to determine the feasibility of introducing such a template for identification of quality of care during an OA consultation, describe quality of care for OA consultations in practices in which the template was introduced and assess the effect of the template on clinician behaviour, including pharmacological and some non-pharmacological aspects of management.
Source...