Knee Osteoarthritis Care: A Quality Improvement Intervention in General Practice

Study Overview
=================
Brief Summary
-----------------
The aim of this study is to improve the referral rates to physiotherapy of patients with knee osteoarthritis. The intervention consists of one academic detailing visit directed to general practitioners (GPs)

Detailed Description
-----------------
In Belgium, referral rates to physiotherapy of patients with knee osteoarthritis are low. A surveys shows that only 11% of the patients with knee osteoarthritis are referred for physiotherapy in an early stage of the disease process. Referral to physiotherapy is common after arthroplasty for revalidation, but not in early stage of the disease process. The aim of this study is to increase the referral rate for physiotherapy in an early stage of the disease process. One to three times a year, a large part of Belgian GPs receive an academic detailing visit by an independent medical visitors of Farmaka. Farmaka is a non-profit organization, which is sponsored by the government. Each year, three medical and medication-related themes are developed to provide evidence-based and independent information for primary care management. A visit takes about 20 minutes. The medical visitors of Farmaka will spend 5 minutes of their standard visit to inform GPs about the evidence-based conservative management of knee osteoarthritis with physiotherapy. The information will focus on the referral of patients with knee osteoarthritis to a physiotherapist in an early stage of the disease. To optimize the effect of the referral to physiotherapists, GPs are asked to specify their prescription by adding a clear therapy description 'exercise therapy with aerobic, muscle strengthening and functional exercises'. This information will be summarized on a flyer. This flyer will be distributed to the GPs at the end of the academic detailing visit. The flyer gives more extended information about the approach and treatment of knee osteoarthritis. The information and flyer will only be distributed to the intervention group. For the sample size calculation we want to optimize the referral rate to physiotherapists with 15%. To detect an absolute difference of 15% in referral rate to physiotherapists we need 100 patients in each group ( with significance level of 5%, 1 on 1 allocation and power of 80%). The control group is composed of GPs, visited by Farmaka, who will not receive the additional information on knee osteoarthritis management. After 6 months the GPs of the intervention and control group will receive two case vignettes on the management of knee osteoarthritis. The number of referrals to a physiotherapist of the intervention group and the control group will be compared, as well as the number of specified well-directed prescriptions.

Official Title
-----------------
Improving Current General Practitioners Care: Feasibility and Effectiveness of a Simple Educational Intervention. Knee Osteoarthritis Care: a Quality Improvement in General Practice

Conditions
-----------------
Knee Osteoarthritis

Intervention / Treatment
-----------------
* Procedure: Academic detailing visit arm


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: active GP setting visited by independent medical visitors for academic detailing Exclusion Criteria: not willing to participate not visited by independent medical visitors for academic detailing
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention group Control group (usual care)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Academic detailing visit arm<br>The GPs will receive an academic detailing visit by a medical visitor. GPs will receive information on the conservative evidence-based management of knee osteoarthritis with physiotherapy. The information will be summarized on a flyer for the GPs. | Procedure: Academic detailing visit arm<br>* General Practitioners in the intervention group will receive one academic detailing visit. During this visit the GPs will receive information about the importance of physical therapy in the non-surgical management of knee osteoarthritis. The information will be summarized on an information leaflet for the GP.<br>|
| No Intervention: control group<br>The two case vignettes will also be presented to GP who did not received the intervention. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of referrals to physical therapy of patients with knee osteoarthritis | 2 case vignettes were developed to assess GPs' referral rate | 6 months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of technical investigations ordered by GPs for patients with knee osteoarthritis | 2 case vignettes were developed to assess GPs' request of technical investigations | 6 months after the intervention | 
| Type of pain medication prescribed by GPs for patients with knee osteoarthritis | 2 case vignettes were developed to assess GPs' medication prescriptions | 6 months after the intervention | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
intervention, improvement strategy