title: A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis.
abstract: Primary care management of osteoarthritis (OA) is variable and often inconsistent with clinical practice guidelines (CPGs). This study aimed to identify and synthesize available qualitative evidence on primary care clinicians' views on providing recommended management of OA.
  
  
  
  Eligibility criteria included full reports published in peer-reviewed journals, with data collected directly from primary care clinicians using qualitative methods for collection and analysis. Five electronic databases (MEDLINE, Cochrane Central Register, EMBASE, CINAHL and PsychInfo) were searched to August 2016. Two independent reviewers identified eligible reports, conducted critical appraisal (based on Critical Appraisal Skills Programme (CASP) criteria), and extracted data. Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive new themes. The Confidence in Evidence from Reviews of Qualitative research (CERQual) approach was used to determine a confidence profile for each finding.
  
  
  
  Eight studies involving approximately 83 general practitioners (GPs), 24 practice nurses, 12 pharmacists and 10 physical therapists, from Australia, France, United Kingdom, Germany and Mexico were included. Four barriers were identified as themes 1) OA is not that serious, 2) Clinicians are, or perceive they are, under-prepared, 3) Personal beliefs at odds with providing recommended practice, and 4) Dissonant patient expectations. No themes were enablers. Confidence ratings were moderate or low.
  
  
  
  Synthesising available data revealed barriers that collectively point towards a need to address clinician knowledge gaps, and enhance clinician communication and behaviour change skills to facilitate patient adherence, enable effective conversations and manage dissonant patient expectations.
  
  
  
  PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543].
authors.affiliation: Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia. Electronic address: thor@sutmap.com.
authors.forename: T
authors.initials: T
authors.lastname: Egerton
authors.affiliation: Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia. Electronic address: lauraem@student.unimelb.edu.au.
authors.forename: L E
authors.initials: LE
authors.lastname: Diamond
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Cabrini Health, Melbourne, Australia. Electronic address: rachelle.buchbinder@monash.edu.
authors.forename: R
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: Centre for Health Exercise & Sports Medicine, Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia. Electronic address: k.bennell@unimelb.edu.au.
authors.forename: K L
authors.initials: KL
authors.lastname: Bennell
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Cabrini Health, Melbourne, Australia. Electronic address: susan.slade@monash.edu.
authors.forename: S C
authors.initials: SC
authors.lastname: Slade
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000175:diagnosis / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D058007:Physicians, Primary Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D036301:Qualitative Research
keywords: Osteoarthritis; Primary care; Qualitative; Systematic review