Getting a Grip on Arthritis: an educational intervention for the diagnosis and treatment of arthritis in primary care.

OBJECTIVE: To evaluate a community-based educational intervention designed to improve the diagnosis and treatment of arthritis in primary care. METHODS: The educational intervention, entitled "Getting a Grip on Arthritis", consisted of a 2-day workshop and followup reinforcement activities for healthcare providers (providers) and was supported by a toolkit of written materials for providers and clients. The content of the intervention was designed around 10 arthritis best practices derived from published arthritis guidelines. Five community health centers (CHC) participated as intervention sites and 2 as control sites. Intervention impact was determined through a mailed survey to clients with arthritis. Primary outcome analysis compared responses to questions about arthritis best practices between intervention and control sites at baseline and followup. RESULTS: The workshop was attended by 21 multidisciplinary providers from intervention CHC. At baseline, 423 of 624 eligible and consenting clients completed the survey and 376 of 593 completed the followup survey. At followup clients in the intervention group reported significantly higher referrals to The Arthritis Society therapy program, and were more often provided information on type of arthritis, medications and their side effects, disease management strategies, and arthritis community resources. CONCLUSION: This demonstration project is one of the first to show changes in the management of arthritis in a primary care setting. This project has recently received funding from Health Canada's Primary Health Care Transition Fund for implementation across Canada and is expected to provide a template for use in other chronic diseases.

Using publicly available directories to trace survey nonresponders and calculate adjusted response rates.

In population-based surveys, sample lists are often out of date by the time data collection begins. Consequently, response rates, and the perceived validity of the survey, may be compromised by the unknowing inclusion of ineligible subjects. A strategy to address this issue is ascertainment of survey nonrespondents' eligibility status, enabling post hoc adjustment of response rates. In 1995-1996, population surveys were carried out in two Ontario, Canada, communities. Despite intensive follow-up, the status of 8949 (18.6%) of the 48218 potential subjects in these surveys remained unknown. In response, 500 "unknowns" from each community were randomly selected for tracing by using publicly available telephone directories and, where applicable, city directories. These tracing efforts classified persons into one of three groups: "ineligible" (moved before the mailing), "true nonresponder" (present when the survey was mailed), and "remains unknown" (no directory listing found). Publicly available directories clarified the status of 76.0% of potential participants, reducing the proportion of "unknowns" from 18.6% to 4.6%. Applying the estimated proportions of "ineligibles" from each area resulted in response rates adjusted from 63.8% to 71.2% and from 72.8% to 74.9% in the survey areas. Publicly available directories were used to successfully trace the majority of survey nonresponders, thus strengthening confidence in the survey's results.

Patient and provider factors related to comprehensive arthritis care in a community setting in Ontario, Canada.

OBJECTIVE: To determine factors that correlate with recommendations for nonpharmacologic and pharmacologic interventions (comprehensive therapy) in community dwelling adults. METHODS: Eligible participants were >/= 55 years of age with hip and knee arthritis symptoms and disability. Comprehensive therapy was classified as a recommendation for exercise and weight loss (if required) and any pharmacotherapy. RESULTS: Only one-half of participants received a recommendation for comprehensive therapy. Participants who had seen a specialist and a therapist were almost twice as likely to receive a recommendation for comprehensive therapy. CONCLUSION: In our setting, many people with hip or knee arthritis were not receiving even minimum recommended treatment. Changes in educational and organizational policies are needed to address this situation.