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General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care
BACKGROUND: Osteoarthritis (OA) is diagnosed and managed primarily by general practitioners (GPs). OA guidelines recommend using clinical criteria, without x-ray, for diagnosis, and advising strengthening exercise, aerobic activity and, if appropriate, weight loss as first-line treatments. These rec...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390779/ https://www.ncbi.nlm.nih.gov/pubmed/30886980 http://dx.doi.org/10.1186/s41927-018-0037-4 |
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author | Egerton, Thorlene Nelligan, Rachel K Setchell, Jenny Atkins, Lou Bennell, Kim L |
author_facet | Egerton, Thorlene Nelligan, Rachel K Setchell, Jenny Atkins, Lou Bennell, Kim L |
author_sort | Egerton, Thorlene |
collection | PubMed |
description | BACKGROUND: Osteoarthritis (OA) is diagnosed and managed primarily by general practitioners (GPs). OA guidelines recommend using clinical criteria, without x-ray, for diagnosis, and advising strengthening exercise, aerobic activity and, if appropriate, weight loss as first-line treatments. These recommendations are often not implemented by GPs. To facilitate GP uptake of guidelines, greater understanding of GP practice behaviour is required. This qualitative study identified key factors influencing implementation of these recommendations in the primary-care setting. METHODS: Semi-structured interviews with eleven GPs were conducted, transcribed verbatim, coded by two independent researchers and analysed with an interpretive thematic approach using the COM-B model (Capability/Opportunity/Motivation-Behaviour) as a framework. RESULTS: Eleven themes were identified. Psychological capability themes: knowledge gaps, confidence to effectively manage OA, and skills to facilitate lifestyle change. Physical opportunity themes: system-related factors including time limitations, and patient resources. Social opportunity theme: influences from patients. Reflective motivation themes: GP’s perceived role, and assumptions about people with knee OA. Automatic motivation themes: optimism, habit, and unease discussing weight. The findings demonstrated diverse and interacting influences on GPs’ practice. CONCLUSION: The identified themes provide insight into potential interventions to improve OA management in primary-care settings. Key suggestions include: improvements to OA clinical guidelines; targeting GP education to focus on identified knowledge gaps, confidence, and communication skills; development and implementation of new models of service delivery; and utilising positive social influences to facilitate best-practice behaviours. Complex, multimodal interventions that address multiple factors (both barriers and facilitators) are likely to be necessary. |
format | Online Article Text |
id | pubmed-6390779 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-63907792019-03-18 General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care Egerton, Thorlene Nelligan, Rachel K Setchell, Jenny Atkins, Lou Bennell, Kim L BMC Rheumatol Research Article BACKGROUND: Osteoarthritis (OA) is diagnosed and managed primarily by general practitioners (GPs). OA guidelines recommend using clinical criteria, without x-ray, for diagnosis, and advising strengthening exercise, aerobic activity and, if appropriate, weight loss as first-line treatments. These recommendations are often not implemented by GPs. To facilitate GP uptake of guidelines, greater understanding of GP practice behaviour is required. This qualitative study identified key factors influencing implementation of these recommendations in the primary-care setting. METHODS: Semi-structured interviews with eleven GPs were conducted, transcribed verbatim, coded by two independent researchers and analysed with an interpretive thematic approach using the COM-B model (Capability/Opportunity/Motivation-Behaviour) as a framework. RESULTS: Eleven themes were identified. Psychological capability themes: knowledge gaps, confidence to effectively manage OA, and skills to facilitate lifestyle change. Physical opportunity themes: system-related factors including time limitations, and patient resources. Social opportunity theme: influences from patients. Reflective motivation themes: GP’s perceived role, and assumptions about people with knee OA. Automatic motivation themes: optimism, habit, and unease discussing weight. The findings demonstrated diverse and interacting influences on GPs’ practice. CONCLUSION: The identified themes provide insight into potential interventions to improve OA management in primary-care settings. Key suggestions include: improvements to OA clinical guidelines; targeting GP education to focus on identified knowledge gaps, confidence, and communication skills; development and implementation of new models of service delivery; and utilising positive social influences to facilitate best-practice behaviours. Complex, multimodal interventions that address multiple factors (both barriers and facilitators) are likely to be necessary. BioMed Central 2018-10-26 /pmc/articles/PMC6390779/ /pubmed/30886980 http://dx.doi.org/10.1186/s41927-018-0037-4 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Egerton, Thorlene Nelligan, Rachel K Setchell, Jenny Atkins, Lou Bennell, Kim L General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title | General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title_full | General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title_fullStr | General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title_full_unstemmed | General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title_short | General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
title_sort | general practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390779/ https://www.ncbi.nlm.nih.gov/pubmed/30886980 http://dx.doi.org/10.1186/s41927-018-0037-4 |
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