title: Quality of care for OA: the effect of a point-of-care consultation recording template.
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)].
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  http://www.controlled-trials.com/ISRCTN06984617/mosaics.
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK j.j.edwards@keele.ac.uk.
authors.forename: John J
authors.initials: JJ
authors.lastname: Edwards
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: George
authors.initials: G
authors.lastname: Peat
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: John
authors.initials: J
authors.lastname: Bedson
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Croft
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hay
authors.affiliation: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000628:therapy*; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment; D026741:Physical Therapy Modalities; D019095:Point-of-Care Systems; D011320:Primary Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D061217:Weight Reduction Programs
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: computerized; medical record systems; osteoarthritis; primary care; quality indicator; reminder systems