Implementing arthritis clinical practice guidelines in primary care.
BACKGROUND
Multi-faceted interventions are among the strongest methods for changing provider behavior.


OBJECTIVE
This paper reports the design, implementation and process evaluation of an educational program to disseminate clinical practice guidelines (CPGs) on the management of rheumatoid arthritis (RA) and osteoarthritis (OA) in primary care.


METHODS
Organizations were invited to participate in inter-professional workshops on OA and RA followed by six months of activities to support the delivery of care in the community. Confidence in ability to manage arthritis was assessed at baseline using a 10 point numerical rating scale. Qualitative assessments were done immediately and 3-12 months post workshop.


RESULTS
646 multidisciplinary providers from 216 organizations attended one of 30 workshops. Providers (n = 584) reported moderate confidence in managing arthritis: family physicians: mean: SD = 7.46(1.42), n = 145; nurse practitioners: 6.10(1.84), n = 73; other health care professionals: 5.23(2.83), n = 389. Participants identified team learning, the opportunity to network and the involvement of trained patient educators as strong features of the workshops. At follow-up, participants indicated the greatest impact of the program was on collaborative care (83%) and patient self-management (79%).


CONCLUSIONS
Qualitative results suggest that inter-professional learning may be a successful strategy for improving the delivery of collaborative arthritis care and supporting patient self-management.
Lineker
Sydney C
SC
The Arthritis Society, Toronto Western Research Institute, Toronto, ON, Canada. slineker@arthritis.ca
Bell
Mary J
MJ
Boyle
Jennifer
J
Badley
Elizabeth M
EM
Flakstad
Lois
L
Fleming
John
J
Lyddiatt
Anne
A
Macdonald
Jane
J
McCarthy
Jack
J
Zummer
Michel
M
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D002983:Clinical Competence; D017408:Guidelines as Topic; D006801:Humans; D010003:Osteoarthritis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care; D016730:Program Development; D015397:Program Evaluation