title: Implementing arthritis clinical practice guidelines in primary care.
abstract: 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.
authors.affiliation: The Arthritis Society, Toronto Western Research Institute, Toronto, ON, Canada. slineker@arthritis.ca
authors.forename: Sydney C
authors.initials: SC
authors.lastname: Lineker
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Bell
authors.forename: Jennifer
authors.initials: J
authors.lastname: Boyle
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.forename: Lois
authors.initials: L
authors.lastname: Flakstad
authors.forename: John
authors.initials: J
authors.lastname: Fleming
authors.forename: Anne
authors.initials: A
authors.lastname: Lyddiatt
authors.forename: Jane
authors.initials: J
authors.lastname: Macdonald
authors.forename: Jack
authors.initials: J
authors.lastname: McCarthy
authors.forename: Michel
authors.initials: M
authors.lastname: Zummer
mesh_terms: 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