title: Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol.
abstract: BACKGROUND
  There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain.
  
  
  METHODS
  A mixed methods study with a nested cluster randomised controlled trial.
  
  
  METHODS
  This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.
  
  
  CONCLUSIONS
  The main output from the study will be to determine whether the MOAC intervention is clinically and cost effective. Additional outputs will be the development of the MOAC for patients consulting with joint pain in primary care, training and educational materials, and resources for patients and professionals regarding supported self-management and uptake of NICE guidance.
  
  
  BACKGROUND
  ISRCTN number: ISRCTN06984617.
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
authors.forename: Emma L
authors.initials: EL
authors.lastname: Healey
authors.forename: Mark
authors.initials: M
authors.lastname: Porcheret
authors.forename: Bie Nio
authors.initials: BN
authors.lastname: Ong
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Main
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.forename: Martyn
authors.initials: M
authors.lastname: Lewis
authors.forename: John J
authors.initials: JJ
authors.lastname: Edwards
authors.forename: Clare
authors.initials: C
authors.lastname: Jinks
authors.forename: Andrew
authors.initials: A
authors.lastname: Morden
authors.forename: Gretl A
authors.initials: GA
authors.lastname: McHugh
authors.forename: Sarah
authors.initials: S
authors.lastname: Ryan
authors.forename: Andrew
authors.initials: A
authors.lastname: Finney
authors.forename: Sue
authors.initials: S
authors.lastname: Jowett
authors.forename: Raymond
authors.initials: R
authors.lastname: Oppong
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Afolabi
authors.forename: Angela
authors.initials: A
authors.lastname: Pushpa-Rajah
authors.forename: June
authors.initials: J
authors.lastname: Handy
authors.forename: Kris
authors.initials: K
authors.lastname: Clarkson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mason
authors.forename: Tracy
authors.initials: T
authors.lastname: Whitehurst
authors.forename: Rhian W
authors.initials: RW
authors.lastname: Hughes
authors.forename: Peter R
authors.initials: PR
authors.lastname: Croft
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D004502:Education, Medical, Continuing / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D058006:General Practice / Q000193:education / Q000379:methods*; D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education; D006284:Health Plan Implementation; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010003:Osteoarthritis / Q000191:economics / Q000628:therapy*; D010348:Patient Care Team; D017060:Patient Satisfaction; D016544:Patient Simulation; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000191:economics; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom