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Osteoarthritis guidelines: Barriers to implementation and solutions
Sarah Ferreira de Meneses1, Francois Rannou2, David J Hunter3
1Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
Abstract:
Osteoarthritis (OA) is a leading cause of disability worldwide. Clinical practice guidelines (CPGs) have been developed to facilitate improved OA management. Scientific communities worldwide have proposed CPGs for OA treatment. Despite the number of highly prominent guidelines available and their remarkable consistency, their uptake has been suboptimal. Possibly because of the multitude of barriers related to the implementation of CPGs. For example, different guidelines show contradictions, some lack evidence, and they lack a hierarchy or tools to facilitate their translation and application. Also, the guidelines do not acknowledge the effect of comorbidities on choosing the treatments. Finally, poor integration of multidisciplinary services within and across healthcare settings is a major barrier to the effective implementation of management guidelines. Here we describe the main problems related to the OA guidelines and some solutions so as to offer some guidance on the elaboration of future CPGs and their implementation in primary care.
Insights
Clinical practice guidelines for osteoarthritis (OA) management show suboptimal uptake due to implementation barriers. Future guidelines need improved structure, evidence, and integration with comorbidity management and multidisciplinary care.
Area of Science:
- Rheumatology
- Evidence-Based Medicine
- Healthcare Management
Background:
- Osteoarthritis (OA) is a major global cause of disability.
- Clinical practice guidelines (CPGs) aim to improve OA management.
- Despite consistent recommendations, OA CPGs have suboptimal uptake.
Purpose of the Study:
- Identify barriers to OA CPG implementation.
- Propose solutions for future OA CPG development and primary care integration.
Main Methods:
- Analysis of existing OA clinical practice guidelines.
- Identification of common implementation challenges.
- Formulation of recommendations for guideline improvement.
Main Results:
- Guidelines exhibit contradictions and lack evidence-based hierarchy.
- Comorbidities are not adequately addressed in treatment selection.
- Poor integration of multidisciplinary services hinders guideline application.
Conclusions:
- Addressing guideline inconsistencies and lack of evidence is crucial.
- Future CPGs must incorporate comorbidity considerations.
- Enhanced integration of multidisciplinary care is essential for effective OA management in primary care.
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