PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

Abstract

ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service delivery to implement recommended care for people with knee osteoarthritis (OA) in a primary care setting.MethodsThree development stages occurred concurrently and iteratively. Each stage considered the healthcare context and was informed by stakeholder input. Stage 1 involved the design of a new model of service delivery (PARTNER). Stage 2 developed a behavioural change intervention targeting general practitioners (GPs) using the behavioural change wheel framework. In stage 3, the ‘Care Support Team’ component of the service delivery model was operationalised.ResultsThe focus of PARTNER is to provide patients with education, exercise and/or weight loss advice, and facilitate effective self-management through behavioural change support. Stage 1 model design: based on clinical practice guidelines, known evidence practice gaps in current care, chronic disease management frameworks, input from stakeholders and the opportunities and constraints afforded by the Australian primary care context, we developed the PARTNER service-delivery model. The key components are: (1) an effective GP consultation and (2) follow-up and ongoing care provided remotely (telephone/email/online resources) by a ‘Care Support Team’. Stage 2 GP behavioural change intervention: a multimodal behavioural change intervention was developed comprising a self-audit/feedback activity, online professional development and desktop software to provide decision support, patient information resources and a referral mechanism to the ‘Care Support Team’. Stage 3 operationalising the ‘care support team’—staff recruited and trained in evidence-based knee OA management and behavioural change methodology.ConclusionThe PARTNER model is the result of a comprehensive implementation strategy development process using evidence, behavioural change theory and intervention development guidelines. Technologies for scalable delivery were harnessed and new primary evidence was generated as part of the process.Trial registration number ACTRN12617001595303 (UTN U1111-1197-4809)

Effectiveness of a New Service Delivery Model for Management of Knee Osteoarthritis in Primary Care: A Cluster Randomized Controlled Trial

“…Our pragmatic CRCT was codesigned with a range of stakeholders ( 26 ), and the feasibility of the main components was tested in a pilot study prior to commencement ( 35 ). Patient care was tailored, with the main CST components delivered to >85% of patients referred.…”

“…Intervention (PARTNER model). Detailed descriptions of the PARTNER model, its development, and implementation plan have been described previously (12,14,(26)(27)(28). Briefly, PARTNER was underpinned by evidence-based clinical practice guidelines (32), the Chronic Care model (33), and extensive stakeholder input from health professionals and managers, policy makers, health insurers, behavior change experts, peak consumer bodies, and consumers.…”

“…Telehealth offers an excellent opportunity to deliver coordinated evidence‐based care and overcome barriers to accessing health services such as shortages of trained clinicians, large distances and geography, inconvenience, and more recently, COVID‐19 considerations ( 25 ). These factors, and the known barriers to recommended knee OA care, informed the design of our new model of knee OA service delivery ( 12 , 14 , 26 ).…”

Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol

“…Efforts to optimise evidence-based non-surgical treatments have led to the development and implementation of primary care-based OA management programmes (OAMPs) internationally [16][17][18][19] . In response to growing international development of OAMPs, the Osteoarthritis Research Society International (OARSI) OAMP Joint Effort Initiative (JEI) has been established.…”

Primary care-based models of care for osteoarthritis: a scoping review protocol

“…OA places a substantial burden on the individual, the community and the health system 7 . At the individual level, OA contributes to considerable physical and psychosocial burden, frequently resulting in significant pain, physical disability, sleep interruption, poorer quality-of-life, depression, impaired work and social participation, and higher healthcare costs 8 , 9 . Commonly co-morbid with other chronic health conditions such as hypertension, heart disease and diabetes 10 , OA negatively impacts upon the morbidity and mortality associated with these conditions 11 .…”