A M Briggs1, E Houlding2, R S Hinman3, L A Desmond4, K L Bennell5, B Darlow6, T Pizzari7, M Leech8, C MacKay9, P J Larmer10, A Bendrups11, A M Greig12, A Francis-Cracknell13, J E Jordan14, H Slater15. 1. School of Physiotherapy and Exercise Science, Curtin University, Australia. Electronic address: A.Briggs@curtin.edu.au. 2. School of Physiotherapy and Exercise Science, Curtin University, Australia; Faculty of Science, University of Ottawa, Ontario, Canada. Electronic address: ehoul060@uottawa.ca. 3. Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy, University of Melbourne, Australia. Electronic address: ranash@unimelb.edu.au. 4. Department of Medicine, Western Health, Victoria, Australia. Electronic address: lucyannedesmond@gmail.com. 5. Centre for Health, Exercise and Sports Medicine; Department of Physiotherapy, University of Melbourne, Australia. Electronic address: k.bennell@unimelb.edu.au. 6. Department of Primary Health Care and General Practice, University of Otago, New Zealand. Electronic address: ben.darlow@otago.ac.nz. 7. La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia. Electronic address: t.pizzari@latrobe.edu.au. 8. Faculty of Medicine Nursing and Health Sciences, Monash University, Australia. Electronic address: michelle.leech@monash.edu. 9. Toronto Rehabilitation Institute, University Health Network, Canada. Electronic address: crystal.mackay@utoronto.ca. 10. School of Clinical Sciences, Auckland University of Technology, New Zealand. Electronic address: peter.larmer@aut.ac.nz. 11. Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Australia. Electronic address: andrea.bendrups@unimelb.edu.au. 12. Department of Physical Therapy, University of British Columbia, Canada. Electronic address: alison.greig@ubc.ca. 13. Department of Physiotherapy, Monash University, Australia. Electronic address: alison.francis-cracknell@monash.edu. 14. HealthSense (Aust) Pty, Ltd, Victoria, Australia. Electronic address: healthsense_aust@bigpond.com. 15. School of Physiotherapy and Exercise Science, Curtin University, Australia. Electronic address: H.Slater@curtin.edu.au.
Abstract
OBJECTIVE: Consistent evidence-practice gaps in osteoarthritis (OA) care are observed in primary care settings globally. Building workforce capacity to deliver high-value care requires a contemporary understanding of barriers to care delivery. We aimed to explore barriers to OA care delivery among clinicians and students. DESIGN: A cross-sectional, multinational study sampling clinicians (physiotherapists, primary care nurses, general practitioners (GPs), GP registrars; total possible denominator: n = 119,735) and final-year physiotherapy and medical students (denominator: n = 2,215) across Australia, New Zealand and Canada. Respondents answered a survey, aligned to contemporary implementation science domains, which measured barriers to OA care using categorical and free-text responses. RESULTS: 1886 clinicians and 1611 students responded. Items within the domains 'health system' and 'patient-related factors' represented the most applicable barriers experienced by clinicians (25-42% and 20-36%, respectively), whereas for students, 'knowledge and skills' and 'patient-related factors' (16-24% and 19-28%, respectively) were the most applicable domains. Meta-synthesis of qualitative data highlighted skills gaps in specific components of OA care (tailoring exercise, nutritional/overweight management and supporting positive behaviour change); assessment, measurement and monitoring; tailoring care; managing case complexity; and translating knowledge to practice (especially among students). Other barriers included general infrastructure limitations (particularly related to community facilities); patient-related factors (e.g., beliefs and compliance); workforce-related factors such as inconsistent care and a general knowledge gap in high-value care; and system and service-level factors relating to financing and time pressures, respectively. CONCLUSIONS: Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).
OBJECTIVE: Consistent evidence-practice gaps in osteoarthritis (OA) care are observed in primary care settings globally. Building workforce capacity to deliver high-value care requires a contemporary understanding of barriers to care delivery. We aimed to explore barriers to OA care delivery among clinicians and students. DESIGN: A cross-sectional, multinational study sampling clinicians (physiotherapists, primary care nurses, general practitioners (GPs), GP registrars; total possible denominator: n = 119,735) and final-year physiotherapy and medical students (denominator: n = 2,215) across Australia, New Zealand and Canada. Respondents answered a survey, aligned to contemporary implementation science domains, which measured barriers to OA care using categorical and free-text responses. RESULTS: 1886 clinicians and 1611 students responded. Items within the domains 'health system' and 'patient-related factors' represented the most applicable barriers experienced by clinicians (25-42% and 20-36%, respectively), whereas for students, 'knowledge and skills' and 'patient-related factors' (16-24% and 19-28%, respectively) were the most applicable domains. Meta-synthesis of qualitative data highlighted skills gaps in specific components of OA care (tailoring exercise, nutritional/overweight management and supporting positive behaviour change); assessment, measurement and monitoring; tailoring care; managing case complexity; and translating knowledge to practice (especially among students). Other barriers included general infrastructure limitations (particularly related to community facilities); patient-related factors (e.g., beliefs and compliance); workforce-related factors such as inconsistent care and a general knowledge gap in high-value care; and system and service-level factors relating to financing and time pressures, respectively. CONCLUSIONS: Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).
Authors: Helen Slater; Joanne E Jordan; Peter B O'Sullivan; Robert Schütze; Roger Goucke; Jason Chua; Allyson Browne; Ben Horgan; Simone De Morgan; Andrew M Briggs Journal: Pain Date: 2022-04-06 Impact factor: 7.926
Authors: Jason A Wallis; Christian J Barton; Natasha K Brusco; Joanne L Kemp; James Sherwood; Kirby Young; Sophie Jennings; Adrian Trivett; Ilana N Ackerman Journal: Musculoskeletal Care Date: 2021-03-12
Authors: Andrew M Briggs; Jennifer G Persaud; Marie L Deverell; Samantha Bunzli; Brigitte Tampin; Yuka Sumi; Olav Amundsen; Elizabeth Mg Houlding; Anontella Cardone; Thora Hugosdottir; Sophia Rogers; Miklós Pozsgai; Helen Slater Journal: BMJ Glob Health Date: 2019-09-11
Authors: Kim L Bennell; Catherine Keating; Belinda J Lawford; Alexander J Kimp; Thorlene Egerton; Courtney Brown; Jessica Kasza; Libby Spiers; Joseph Proietto; Priya Sumithran; Jonathan G Quicke; Rana S Hinman; Anthony Harris; Andrew M Briggs; Carolyn Page; Peter F Choong; Michelle M Dowsey; Francis Keefe; Christine Rini Journal: BMC Musculoskelet Disord Date: 2020-03-12 Impact factor: 2.362
Authors: Andrew M Briggs; Rana S Hinman; Ben Darlow; Kim L Bennell; Michelle Leech; Tania Pizzari; Alison M Greig; Crystal MacKay; Andrea Bendrups; Peter J Larmer; Alison Francis-Cracknell; Elizabeth Houlding; Lucy A Desmond; Joanne E Jordan; Novia Minaee; Helen Slater Journal: ACR Open Rheumatol Date: 2019-05-22
Authors: Thorlene Egerton; Rana S Hinman; David J Hunter; Jocelyn L Bowden; Philippa J A Nicolson; Lou Atkins; Marie Pirotta; Kim L Bennell Journal: BMJ Open Date: 2020-10-07 Impact factor: 2.692