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Original Research |

IMPROVING PATIENT CARE

A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical TrialPatient and Provider Intervention for Osteoarthritis Management in Veterans

Kelli D. Allen, PhD; William S. Yancy Jr., MD, MHS; Hayden B. Bosworth, PhD; Cynthia J. Coffman, PhD; Amy S. Jeffreys, MStat; Santanu K. Datta, PhD, MHS; Jennifer McDuffie, PhD; Jennifer L. Strauss; and Eugene Z. Oddone, MD, MHSc
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 22 December 2015.


From Durham VA Medical Center, Duke University, and Duke University Medical Center, Durham, North Carolina, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Veterans Affairs.

Acknowledgment: The authors thank the Ambulatory Care Service of the Durham VA Medical Center for participation in the study; study team members Jennifer Chapman, Karen Juntilla, and Laurie Marbrey; and all of the veterans who participated in this study.

Financial Support: This project was supported by the Department of Veterans Affairs, Health Services Research and Development Service (IIR 10-126). Dr. Bosworth is funded by a Career Scientist award (08-027).

Disclosures: Dr. Allen reports grants from the Department of Veterans Affairs Health Services Research and Development Service during the conduct of the study. Dr. Yancy reports grants from the Department of Veterans Affairs during the conduct of the study and personal fees from Nutrisystem and University of Pennsylvania/Weight Watchers International outside the submitted work. Dr. Bosworth reports grants from the National Institutes of Health during the conduct of the study; grants from Sanofi, Johnson & Johnson, Takeda Pharmaceutical Company, and the PhRMA Foundation outside the submitted work; and personal fees from CVS and Walgreens outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=M15-0378.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Reproducible Research Statement:Study protocol: Available from Dr. Allen (e-mail, Kelli.allen@va.gov). Statistical code and data set: Available to approved persons through agreement with the authors (e-mail, Kelli.allen@va.gov).

Requests for Single Reprints: Kelli D. Allen, PhD, Health Services Research and Development (152), Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705; e-mail, Kelli.allen@va.gov.

Current Author Addresses: Drs. Allen, Yancy, Bosworth, Coffman, Datta, McDuffie, and Oddone; Ms. Jeffreys; and Ms. Strauss: Health Services Research and Development (152), Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705.

Author Contributions: Conception and design: K.D. Allen, W.S. Yancy, H.B. Bosworth, C.J. Coffman, S.K. Datta, J. McDuffie, J.L. Strauss, E.Z. Oddone.

Analysis and interpretation of the data: K.D. Allen, W.S. Yancy, H.B. Bosworth, C.J. Coffman, A.S. Jeffreys, S.K. Datta, J. McDuffie, E.Z. Oddone.

Drafting of the article: K.D. Allen, H.B. Bosworth, C.J. Coffman, S.K. Datta.

Critical revision of the article for important intellectual content: K.D. Allen, W.S. Yancy, H.B. Bosworth, C.J. Coffman, A.S. Jeffreys, S.K. Datta, E.Z. Oddone.

Final approval of the article: K.D. Allen, W.S. Yancy, H.B. Bosworth, C.J. Coffman, A.S. Jeffreys, S.K. Datta, J. McDuffie, J.L. Strauss, E.Z. Oddone.

Provision of study materials or patients: S.K. Datta, J. McDuffie.

Statistical expertise: C.J. Coffman, A.S. Jeffreys, S.K. Datta.

Obtaining of funding: K.D. Allen, W.S. Yancy, C.J. Coffman, S.K. Datta.

Administrative, technical, or logistic support: K.D. Allen, C.J. Coffman, E.Z. Oddone.

Collection and assembly of data: C.J. Coffman, J. McDuffie.


Ann Intern Med. 2016;164(2):73-83. doi:10.7326/M15-0378
Text Size: A A A

Background: Management of osteoarthritis requires both medical and behavioral strategies, but some recommended therapies are underused.

Objective: To examine the effectiveness of a combined patient and provider intervention for improving osteoarthritis outcomes.

Design: Cluster randomized clinical trial with assignment to osteoarthritis intervention and usual care groups. (ClinicalTrials.gov: NCT01130740)

Setting: Department of Veterans Affairs Medical Center in Durham, North Carolina.

Participants: 30 providers (clusters) and 300 outpatients with symptomatic hip or knee osteoarthritis.

Intervention: The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved delivery of patient-specific osteoarthritis treatment recommendations to primary care providers through the electronic medical record.

Measurements: The primary outcome was total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months. Secondary outcomes were WOMAC function and pain subscale scores, physical performance (Short Physical Performance Battery), and depressive symptoms (Patient Health Questionnaire-8). Linear mixed models that were adjusted for clustering of providers assessed between-group differences in improvement in outcomes.

Results: At 12 months, WOMAC scores were 4.1 points lower (indicating improvement) in the osteoarthritis intervention group versus usual care (95% CI, −7.2 to −1.1 points; P = 0.009). WOMAC function subscale scores were 3.3 points lower in the intervention group (CI, −5.7 to −1.0 points; P = 0.005). WOMAC pain subscale scores (P = 0.126), physical performance, and depressive symptoms did not differ between groups. Although more patients in the osteoarthritis intervention group received provider referral for recommended osteoarthritis treatments, the numbers who received them did not differ.

Limitation: The study was conducted in a single Veterans Affairs medical center.

Conclusion: The combined patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.

Primary Funding Source: Department of Veterans Affairs, Health Services Research and Development Service.

Figures

Grahic Jump Location
Figure.

Study flow diagram.

PCP = primary care provider; VA = Department of Veterans Affairs.

* 1 patient switched from a usual care provider to an osteoarthritis intervention provider before being notified of randomization and was analyzed with the osteoarthritis intervention group.

† 1 became ineligible after giving consent, 1 had hip or knee surgery, and 1 developed a serious health condition.

‡ 1 became ineligible after giving consent, 2 had hip or knee surgery, 1 moved out of the area, and 1 changed health care providers before treatment recommendations were issued.

§ 6 had hip or knee surgery and 1 developed a serious health condition.

|| 1 had hip or knee surgery and 1 developed a serious health condition.

Grahic Jump Location

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