Referral of people with osteoarthritis to self-management programmes: barriers and enablers identified by general practitioners.
ABSTRACT We conducted a qualitative descriptive study involving general practitioners (GPs) in Victoria, Australia, to examine the barriers to, and drivers of, referral of patients with osteoarthritis (OA) to self-management programmes.
Participating GPs were asked to respond to a series of open-ended questions regarding their referral of patients with OA to self-management programmes and their perception of the advantages and disadvantages of these programmes for people with OA. Interviews were audio-taped, transcribed verbatim, and analysed to identify primary themes in the data.
Results suggest current referral of OA patients to self-management programmes from within general practice is influenced by GP-related factors, patient-related factors, and programme-related factors. A major barrier to referral was GPs limited knowledge about the availability of local programmes and the types of services these programmes provide to people with OA. Some GPs felt OA is less conducive to self-management interventions compared to other chronic conditions (e.g., diabetes, asthma) and questioned the clinical benefit of programmes for people with OA. Enablers of GP referral included GP knowledge about content and availability of programmes, positive GP attitudes towards patient involvement in these programmes, and patient awareness of the value and availability of these programmes (i.e., patient-mediated referral).
This study suggests multiple barriers and drivers of referral of patients with OA to self-management programmes that could be targeted in the future in order to increase referral to, and uptake of, these programmes in general practice.
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ABSTRACT: To assess therapeutic education program impact for lower limb osteoarthritis (OA) at both the medical and surgical stage. Factors limiting efficiency and implementation of these programs such as patients' beliefs will be highlighted. A non systematic literature review on Medline and Cochrane Library databases from 1966 to 2009 using following key words "knee/hip osteoarthritis", "self-care/therapeutic education", "total hip/knee replacement/arthroplasty", "patients' beliefs" is conducted. Clinical trials and randomized clinical trials, as well as literature reviews and practice guidelines, published in English and French will be analysed. Therapeutic education is part of the non-pharmacological management of chronic illnesses such as OA. The aim of education at an early stage of OA is to change patients' lifestyle, especially the regular practice of physical activity and weight reduction. Fears and avoidance assessment is necessary before patients' education process. When a surgical option is considered, the aim of education is to hasten patient recovery, improve autonomy after surgery, facilitate the return home and reduce the rate of transfer to a rehabilitation unit. The efficacy of therapeutic education could be optimised for the management of OA with use of standardized rules and methods to deliver information and education. One way to improve therapeutic education in the management of OA could be to propose dedicated continuing medical education programs supported by specific economic sources for health care professionals.Annals of physical and rehabilitation medicine 01/2010; 53(6-7):434-50.
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ABSTRACT: Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series.In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals' behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series.Implementation Science 04/2012; 7:35. · 2.37 Impact Factor
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ABSTRACT: To evaluate the extent to which the principles of chronic pain or illness self-management (SM) programs might be adapted to focus on the workplace concerns of adults with persistent or recurrent pain and lead to new workplace intervention opportunities. Eight SM programs were selected as representative evidence-based programs and then compared to extract common instructional elements. Elements were analyzed for potential application to four workplace problem domains identified by workers with pain: activity interference, negative self-perceptions, interpersonal challenges, and the inflexibility of work. Of 24 instructional elements, 17 were shared by at least half of the SM programs. Instructional elements judged to be best suited for dealing with workplace concerns included those focused on reducing pain and discomfort, making informed decisions, communicating effectively, and dealing with thoughts and feelings. However, aspects of the workplace that may alter the feasibility or effectiveness of SM strategies include the level of physical demands and limitations, job leeway, and the nature of workplace roles and relationships. Principles and methods of SM intervention programs are generally well suited to address pain-related problems in the workplace, but tailoring of messages may be necessary to incorporate the unique organizational, physical, and social aspects of work into psycho-educational programs.Disability and Rehabilitation 01/2012; 34(8):694-703. · 1.54 Impact Factor