Title: Enhancing quality care for older adults with osteoarthritis: a knowledge mobilization case study and recommendations for primary care
Funder: Department of Health and Social Care

Abstract: The Global Burden of Disease Study shows that musculoskeletal conditions are the number one cause of chronic disability worldwide, accounting for 30% of all years lived with disability and representing an increase of 25% in the last decade. The current UK National Health budget for musculoskeletal disease is 10 billion, the third largest after mental health and cardiac disease. Of the 300 million general practice consultations which occur in England every year, approximately 1 in 6 are for arthritis and musculoskeletal problems. Over the past six years the Institute of Primary Care Sciences, Keele University has been undertaking an NIHR funded osteoarthritis programme to optimise the care and management for people presenting in primary care with osteoarthritis (OA). It builds on the National Institute of Health and Care Excellence (NICE) OA recommendations. Our OA Programme developed four key innovations: an OA guidebook written by patients and health professionals for patients; a model OA consultation for primary care; training for general practitioners and practice nurses to deliver the model consultation; quality indicators of OA care. This Knowledge Mobilisation Research Fellowship builds upon the applicant's career in applied research in musculoskeletal therapies; extensive networks in research, practice and PPI; a strong partnership between Keele and the eight CCGs in Staffordshire and Shropshire (Primary Care Research Consortium and Staffordshire and Shropshire READIE group); and collaborations with the West Midlands (WM) Academic Health Sciences Network (AHSN) and Collaborative Leadership for Applied Health Research and Care (CLAHRC WM & Greater Manchester), to deliver two overarching aims: To develop a knowledge mobilisation case study from the NIHR programme improving quality of primary care in consultations for osteoarthritis (OA). To develop a set of knowledge mobilisation recommendations for primary care. Each aim has four work packages: 1.1 Identify key stakeholders and develop a Community of Practice (CoP) to include researchers, Clinical Commissioning Group Research & Development Leads, experts in knowledge mobilisation theory and practice, health care professionals, Patients and Public Involvement (PPI). 1.2. Develop a PPI Knowledge Broker role to enhance PPI in knowledge mobilisation activities 1.3. Develop and deliver a knowledge mobilisation package using key innovations developed from an NIHR osteoarthritis programme to improve quality of care in general practice consultations for OA 1.4. Write up the process as a knowledge mobilisation case study from an NIHR programme. 2.1 Modify the Short Clinical Guideline methodology of the National Institute for Health and Care Excellence (NICE, 2012) for developing recommendations for knowledge mobilisation in primary care 2.2 Map the case study developed in 1 to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy using best evidence for translating research on complex interventions into primary care 2.3 Using representatives from the CoP refine the mapping in work package 2.2 and develop a set of knowledge mobilisation recommendations for primary care using methods in work package 2.1 2.4 Explore the generalizability of the recommendations for primary care. This Fellowship will be based in the Institute of Primary Care and Health Sciences, ranked the 5th most successful primary care department in the UK. The Institute will fund a PhD studentship to deliver the research component under supervision. Through the PhD studentship and PPI Knowledge Broker the Fellow will: establish knowledge mobilisation of arthritis research for primary care develop key recommendations for knowledge mobilisation in primary care facilitate a PPI Knowledge Broker in speeding up the implementation of research ensure results from research feed in to NIHR Knowledge Mobilisation strategies, CLAHRC diffusion strategies and AHSN implementation plans demonstrate the impact of knowledge brokering on improving patient outcomes in primary care supervise a Knowledge Mobilisation PhD to completion.

Lay abstract: Long term conditions are a major cause of disability worldwide and musculoskeletal conditions such as arthritis and low back pain are some of the leading causes of this disability. Osteoarthritis for example has become the main cause of physical disability in older adults. This is partly due to the increase in the number of people of older ages who experience joint pain and partly because risk factors for poorer health such as being overweight and reduced physical activity have also increased. Sitting is the new smoking' is one of the latest public health messages. Osteoarthritis is primarily managed in primary care in the UK and there is evidence that people with osteoarthritis are more likely to receive tablets and medicines (pharmacological treatments) than exercises and support for self-management (non-pharmacological treatments) from their general practitioner. The Institute of Primary Care and Health Sciences at Keele University has just completed an osteoarthritis research programme funded by the National Institute of Health Research which focused on optimizing quality primary care for osteoarthritis. Recommendations for the care and management of people with osteoarthritis include core treatments such as written information, advice on exercise and physical activity, and if overweight advice on weight loss and these core treatments should be offered to all people consulting a healthcare professional. The research programme developed and tested four key innovations that could deliver this high quality care as defined by NICE (National Institute of Health and Care Excellence):1. An osteoarthritis guidebook written by patients and health professionals for patients 2. A model osteoarthritis consultation for primary care 3. Training for general practitioners and practice nurses to deliver the model consultation 4. The development of measures of quality care.Using these key innovations the Knowledge Mobilisation Research Fellow will firstly demonstrate how research can be taken into real world practice to improve quality of primary care in consultations for osteoarthritis (OA). This will be done in partnership with two Clinical Commissioning Groups (CCGs) in the West Midlands and will result in a case study. Secondly the Fellow will use the case study to develop a set of recommendations for primary care to ensure that lessons learnt about translating research findings into every day practice can be shared with others. The Fellow's Institute will fund a PhD studentship to study the processes outlined above and the student will work under the supervision of the Fellow who is an experienced musculoskeletal therapy researcher. The Fellowship will also fund a PPI Knowledge Broker someone who bridges the gap between research and patients to ensure that Patient and Public Involvement (PPI) is embedded throughout the whole Fellowship and knowledge mobilisation. The Institute's PPI Research User Group has highlighted that getting the results of research into practice should be a priority for researchers. This Fellowship builds upon the applicant's research career and extensive networks in research, clinical practice and patient and public engagement. It combines the expertise of one of the leading research institutes in primary care with work of key stakeholders and collaborators working in the West Midlands and Greater Manchester Regions.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MUSCULOSKELETAL