A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis

Egerton, Thorlene; Diamond, Laura E.; Buchbinder, Rachelle; Bennell, Kim L; Slade, Susan C

doi:10.1016/j.joca.2016.12.002

Cited by 140 publications

(204 citation statements)

References 47 publications

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“…Egerton et al () (Egerton et al, ) and many others have reported the perception that ‘OA is not that serious’ and that ‘personal beliefs are at odds with providing recommended practice’. A body of literature suggests that OA is a low priority to both HCPs and patients, and, that HCPs' personal beliefs do not always align with recommended guidelines (Egerton et al, , Paskins, Sanders, & Hassell, , Paskins, Sanders, & Hassell, , Thomas, Moore, Roddy, & Peat, , Jinks, Ong, & Richardson, ). In addition, findings illustrated how self‐management was not viewed as core business by some GPs and because the condition didn't align to pay‐for‐performance targets, and implementation was reported not to provide any benefits to the practice.…”

Section: Discussionmentioning

confidence: 99%

“…Research exploring the process of implementing evidence‐based guidelines is required to provide insights into the practical, real‐world issues encountered and to develop targeted implementation strategies (Allen et al, ). Previous evidence syntheses have described clinicians' views of the barriers and enablers of the management of OA (Egerton, Diamond, Buchbinder, Bennell, & Slade, ) and factors affecting implementation more broadly across a range of conditions in primary care (Lau et al, ). The perceived barriers to implementation of best practice guidelines for OA across hospital and community settings have also been explored (Brand & Cox, ), however, to date, no study has synthesized the experiences of implementing evidence‐based guidelines for OA in primary care.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing the implementation of evidence‐based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis

Swaithes

Paskins

Dziedzic

et al. 2020

Musculoskeletal Care

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Introduction: Implementation of evidence-based health guidelines in primary care is challenging. This systematic review aimed to synthesize qualitative evidence that investigates the factors influencing the implementation of evidence-based guidelines for osteoarthritis in primary care. Methods: A systematic review of qualitative studies. MEDLINE, EMBASE, CINAHL, HMIC, PsychINFO, Web of Science and Assia were searched (from 2000 to March 2019). The methodological quality of the included studies was assessed by two independent reviewers. Data were analyzed and synthesized using thematic synthesis.Results: 1612 articles were screened and four articles with a total of 87 participants (46 patients, 28 GPs, 13 practice nurses) were included. Three of the studies were conducted in England within the context of an implementation trial and one was conducted in the Netherlands. The thematic synthesis revealed three overarching themes. Best practice was not enough to achieve 'buy-in' to implementation but a range of tacit motivators to implementation were identified. Healthcare professionals used patient reasons to justify engaging or not engaging with implementation. Engaging with the whole practice was important in achieving implementation. A disconnect between research and 'real-world' primary care practice influenced long-term implementation.Conclusions: Despite the relative paucity of current evidence, this systematic review has identified a series of possible disconnects may impact uptake of interventions to improve osteoarthritis care, existing between clinicians and patients, researchers and clinicians, clinicians and guidelines and within general practice itself. There remains a need to further explore the experiences of key stakeholders, including patients involved in implementation for osteoarthritis in primary care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors influencing the implementation of evidence‐based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis

Swaithes

Paskins

Dziedzic

et al. 2020

Musculoskeletal Care

View full text Add to dashboard Cite

show abstract

“…In addition, Hofstede et al found similar barriers for referral to non‐surgical treatment for OA patients in orthopaedic practice (Hofstede et al, ). Egerton et al described in a systematic review similar barriers to the management of osteoarthritis in primary care GPs: GPs tend to trivialize the problem and believe OA to be inevitable and lower priority than other health conditions which may lead to under management of the condition; a lack of knowledge regarding OA guidelines; clinicians' perceptions about the disease, patient adherence and the treatment effectiveness may all lead to variable practice at odds with the recommendations (Egerton, Diamond, Buchbinder, Bennell, & Slade, ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

Rooij

Leeden

Esch

et al. 2020

Musculoskeletal Care

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Objective:The objectives of the present study were to: (1) evaluate the effect of an educational course on competence (knowledge and clinical reasoning) of primary care physical therapists (PTs) in treating patients with knee osteoarthritis (KOA) and comorbidity according to the developed strategy; and (2) identify facilitators and barriers for usage.Method: The present research was an observational study with a pretest-posttest design using mixed methods. PTs were offered a postgraduate course consisting of elearning and two workshops (blended education) on the application of a strategy for exercise prescription in patients with KOA and comorbidity. Competences were measured by questionnaire on knowledge (administered before and 2 weeks after the course), and a patient vignette to measure clinical reasoning (administered before the course and after a 6 month period of treating patients). Facilitators and barriers for using the strategy were assessed by a questionnaire and semi-structured interviews.Results: Thirty-four PTs were included. Competence (knowledge and clinical reasoning) improved significantly (p < 0.01). Fourteen out of 34 PTs had actually treated patients with KOA and comorbidity, during a 6-month period. The strategy was found to be feasible in daily practice. The main barriers included the limited number of (self-) referrals of patients, limited number of reimbursed treatment sessions by insurance companies and a suboptimal collaboration with (referring) physicians. Conclusion:A blended course on exercise therapy for patients with KOA and comorbidity seems to improve PTs' competence through increasing knowledge and clinical reasoning skills. Identified barriers should be solved before large-scale implementation of exercise therapy can take place in these complex patients. K E Y W O R D Sblended education, comorbidity, exercise therapy, knee osteoarthritis, primary care

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“…For example a systematic review by Hendry, Snowden, and Brown (2017) found that mental health nurses' conservative attitudes about clients' sexual health meant nurses avoided conversations about sexuality. Similarly, another systematic review identified that primary care clinicians' personal beliefs about osteoarthritis meant they were less likely to recommended evidence-based treatments (Egerton, Diamond, Buchbinder, Bennell, & Slade, 2017).…”

Section: Discussionmentioning

confidence: 99%

Navigating and negotiating meanings of child abuse and neglect: Sociocultural contexts shaping Australian nurses’ perceptions

Lines

Hutton

Grant

2020

Health Soc Care Community

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Nurses who work with children have the opportunity to make a difference by identifying and responding to child abuse and neglect. Little is known about the ways that nurses define, assess and respond to child abuse and neglect and how this subsequently affects children. This paper reports one of four themes identified through inductive analysis of a qualitative study exploring nurses’ perceptions and experiences of keeping children safe from abuse and neglect. The aim of this paper was to report on how nurses understand and interpret child abuse, is found to be shaped by their own sociocultural contexts. A qualitative research design underpinned by social constructionism framed the study. Data were collected in 2016 and 2017 through 21 in‐depth, semi‐structured interviews with nurses who work with children in Australia. Key findings showed that nurses working with children had difficulty defining child abuse and drew upon multiple sources to construct a working definition. In addition to drawing from official legislation and guidelines, nurses compared and contrasted the level of abuse with their own personal and professional experiences of parenting. Nurses described the challenges of making assessments when faced with cultural practices different from their own. Nurses’ descriptions of how they defined abuse showed that their assessments of child abuse and neglect were inextricably linked to their personal values and beliefs. As such, nurses were often working from their own value systems rather than consistently taking a child‐focussed approach. There was an absence of consistent and explicit critical reflection on ways that values and beliefs might shape practice at individual and system levels. We propose this is a missing aspect of child safe practice. Reflection on how personal and professional values and beliefs interact with the implementation of evidence‐informed approaches will increase nurses’ capacity to maintain a child‐focus.

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A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis

Abstract: PROSPERO (http://www.crd.york.ac.uk/PROSPERO) [4/11/2015, CRD42015027543].

Cited by 140 publications

References 47 publications

Factors influencing the implementation of evidence‐based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis

Factors influencing the implementation of evidence‐based guidelines for osteoarthritis in primary care: A systematic review and thematic synthesis

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

Navigating and negotiating meanings of child abuse and neglect: Sociocultural contexts shaping Australian nurses’ perceptions

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