Title: Development and implementation of support for pharmacists to deliver integrated primary care for osteoarthritis: a mixed methods investigation and evaluation (PharmOA)
Funder: Department of Health and Social Care

Abstract: Research question: How may we best support primary care pharmacists to deliver osteoarthritis care within an integrated primary healthcare system? Background: Osteoarthritis is a common, painful and disabling condition, which often occurs alongside other long-term conditions. People affected by osteoarthritis do not always seek medical advice and, when they do, primary care commonly underuses weight management and exercise, and commonly choses less safe pharmacological approaches. Primary care pharmacists (PCPs; community and in-practice pharmacists) have transferrable skills that make them well placed to deliver care for people with osteoarthritis. However, we do not know what osteoarthritis management by PCPs currently consists of, how patients, healthcare professionals (HCPs) and PCPs feel about PCPs undertaking enhanced roles in delivering care for osteoarthritis and what support is needed by PCPs to fulfil such roles. Aims and Objectives: Our overarching aim is to improve the availability of high quality, consistent care for people with osteoarthritis by developing and supporting an extended, integrated primary healthcare role for PCPs. Five phases will address the following questions: Phase 1: What is known about the role of PCPs in delivering care for chronic pain conditions? Phase 2: What are patient, PCP and HCP views regarding extended PCP roles in delivering osteoarthritis care? Phase 3: How are PCPs best supported to deliver osteoarthritis care? Phase 4: How feasible and acceptable are the PharmOA tools? Phase 5&shy;: How are PCPs best integrated to deliver osteoarthritis care? Methods: Phase 1: Systematic review to summarise literature exploring PCP roles in supporting adults with chronic (non-cancer) pain. Phase 2: Survey of patients, PCPs and HCPs to gather their experiences of, and views about, enhanced pharmacist roles in delivering improved care for patients with osteoarthritis Interviews with patients, PCPs and HCPs to explore areas of dissonance, similarities and uncertainties about the potential extended roles for, and related support needs of, PCPs to deliver care for patients with osteoarthritis Phase 3: Stakeholder codesign will refine existing tools to support extended PCP roles to deliver osteoarthritis care (PharmOA tools) Phase 4: PharmOA tools will be evaluated by two in-practice and two community pharmacists. Evaluation data will be a combination of PharmOA tool usage data and feedback through discussions to inform finalisation of the PharmOA tools Phase 5: Stakeholder codesign to define and prioritise recommendations for the extended role of PCPs delivering osteoarthritis care Timelines for delivery: Phase 1 and 2a will be completed in the first year. Phase 2b, 3, 4 and 5 will run over the second year. At the end of the two year study period, the PharmOA tools and recommendations for enhanced roles of pharmacists delivering care for osteoarthritis will be complete. Anticipated Impact and Dissemination Results dissemination will occur through scientific papers and conferences. The PharmOA tools and recommendations will be ready for use at study end and disseminated via existing networks and social media with the support of our Impact Acceleration Unit. Patients will benefit from improved choice of professional and context when accessing high quality care for their osteoarthritis.

Lay abstract: We aim to find out if pharmacists can help improve the availability of consistent care to people with osteoarthritis. We will do this through developing and testing support for pharmacists. People could seek help from their local pharmacist to manage their osteoarthritis, instead of seeking this from their general practice. This would include advice about how to manage pain and other symptoms with exercise, weight loss, medication, and other aids. This would benefit people with osteoarthritis by making access to high quality, consistent, effective care more readily available and convenient and it gives people greater choice. It will benefit practices by freeing-up appointments to tackle other issues. We are generally living longer. Osteoarthritis is a condition associated with older age, so more people are affected now than ever before. Osteoarthritis causes pain, difficulties in undertaking normal activities and decreases quality of life. The problems caused by osteoarthritis can have a negative impact on society in all sorts of ways. For example, people may stop working or undertaking caring activities, and there is a direct impact on the NHS. We hope to minimise these negative outcomes through improving care. To achieve the project aims, the team will: Review existing studies that have focussed on understanding how pharmacists can support patients with persistent non-cancer pain; Run a survey and interview patients, pharmacists and other health professionals to identify ways that pharmacists could better support people with OA, making sure it is acceptable to all groups; Amend and improve existing tools for pharmacists to make sure they are confident and able to provide care for people with OA. These tools will be developed to work alongside other care providers, so we will consider how pharmacists and general practices can communicate and care be recorded within the patients medical records; Test and evaluate these tools with a small group of pharmacists before finalising them; Develop a set of recommendations for the future role of pharmacists in supporting people with osteoarthritis. People with osteoarthritis highlighted the need and importance of this research. In designing the project, people with osteoarthritis were fully involved in its shaping. There have been two pre-application patient advisory group meetings. The public co-applicant for this project and the post-funding patient advisory groups will make sure that the project remains patient-focussed. They will also assist with the project s dissemination. The final training and support approaches, that is the tools, will be adopted into our existing national and international osteoarthritis implementation ( putting research into practice ) programme. The team will make sure that the results are circulated in the form of scientific articles, presentations at conferences and brief reports and the tools are made available via clinical and academic professional networks and social media.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MUSCULOSKELETAL