Dataset Information

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.

ABSTRACT:

Background

Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care.

Methods / design

One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n?=?300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n?=?560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed.

Discussion

Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings.

Trial registration

NCT01130740 (VA); NCT 01435109 (NIH).

SUBMITTER: Allen KD

PROVIDER: S-EPMC3433311 | biostudies-literature | 2012 Apr

REPOSITORIES: biostudies-literature

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Publications

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.

Allen Kelli D KD Bosworth Hayden B HB Brock Dorothea S DS Chapman Jennifer G JG Chatterjee Ranee R Coffman Cynthia J CJ Datta Santanu K SK Dolor Rowena J RJ Jeffreys Amy S AS Juntilla Karen A KA Kruszewski Jennifer J Marbrey Laurie E LE McDuffie Jennifer J Oddone Eugene Z EZ Sperber Nina N Sochacki Mary P MP Stanwyck Catherine C Strauss Jennifer L JL Yancy William S WS

BMC musculoskeletal disorders 20120424

<h4>Background</h4>Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have poten ...[more]

PMID: 22530979

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Project description:Background:A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. Objective:To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Design:Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). Setting:10 Duke University Health System community-based primary care clinics. Participants:537 outpatients with symptomatic hip or knee osteoarthritis. Intervention:The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. Measurements:The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. Results:No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. Limitations:The study involved 1 health care network. Data on provider referrals were not collected. Conclusion:Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. Primary Funding Source:National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Project description:ImportancePrimary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care.ObjectiveTo measure the effect of PCP turnover on patient experiences of care and ambulatory care quality.Design, setting, and participantsObservational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA). We included all patients enrolled in primary care at the VHA between 2010 and 2012 included in 1 of 2 national data sets used to measure our outcome variables: 326,374 patients in the Survey of Healthcare Experiences of Patients (SHEP; used to measure patient experience of care) associated with 8441 PCPs and 184,501 patients in the External Peer Review Program (EPRP; used to measure ambulatory care quality) associated with 6973 PCPs.ExposuresWhether a patient experienced PCP turnover, defined as a patient whose provider (physician, nurse practitioner, or physician assistant) had left the VHA (ie, had no patient encounters for 12 months).Main outcomes and measuresFive patient care experience measures (from SHEP) and 11 measures of quality of ambulatory care (from EPRP).ResultsNine percent of patients experienced a PCP turnover in our study sample. Primary care provider turnover was associated with a worse rating in each domain of patient care experience. Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% (adjusted percentage point difference, -5.3; 95% CI, -6.0 to -4.7) and a reduced likelihood of getting care quickly of 36.5% vs 38.5% (adjusted percentage point difference, -1.1; 95% CI, -2.1 to -0.1). In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure of 78.7% vs 80.4% (adjusted percentage point difference, -1.44; 95% CI, -2.2 to -0.7). In 9 measures of ambulatory care quality, the difference between patients who experienced no PCP turnover and those who had a PCP turnover was less than 1 percentage point. These effects were moderated by the patients' continuity with their PCP prior to turnover, with a larger detrimental effect of PCP turnover among those with higher continuity prior to the turnover.Conclusions and relevancePrimary care provider turnover was associated with worse patient experiences of care but did not have a major effect on ambulatory care quality.

Dataset Information

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.

Background

Methods / design

Discussion

Trial registration

Publications

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials.

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