Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.
OBJECTIVE
To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice.


METHOD
Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England.


PARTICIPANTS
525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression.


RESULTS
525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3).


CONCLUSION
Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months.


TRIAL REGISTRATION
ISRCTN06984617.
['Dziedzic|K S|KS|', 'Healey|E L|EL|', 'Porcheret|M|M|', 'Afolabi|E K|EK|', 'Lewis|M|M|', 'Morden|A|A|', 'Jinks|C|C|', 'McHugh|G A|GA|', 'Ryan|S|S|', 'Finney|A|A|', 'Main|C|C|', 'Edwards|J J|JJ|', 'Paskins|Z|Z|', 'Pushpa-Rajah|A|A|', 'Hay|E M|EM|']
D000368:Aged D016000:Cluster Analysis D004739:England D005260:Female D058006:General Practice D019983:Guideline Adherence D006801:Humans D008297:Male D008875:Middle Aged D010003:Osteoarthritis D010146:Pain D010147:Pain Measurement D010342:Patient Acceptance of Health Care D010353:Patient Education as Topic D010817:Physician-Patient Relations D017410:Practice Guidelines as Topic D019984:Quality Indicators, Health Care D012017:Referral and Consultation D012648:Self Care D011795:Surveys and Questionnaires D016896:Treatment Outcome
Implementation NICE guidelines Osteoarthritis Primary care Quality indicators Self-management