Pharmacist-Initiated Intervention Trial in OsteoArthritis

To measure the effectiveness of a multi-disciplinary intervention involving pharmacists, physiotherapists and family physicians in the early diagnosis and treatment of individuals who are developing osteoporosis of the knee.

To measure the effectiveness of a multi-disciplinary intervention involving pharmacists, physiotherapists and family physicians in the early diagnosis and treatment of individuals who are developing osteoporosis of the knee.

Research Summary

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of disability in North America. It now affects at least three million Canadians, a number that is expected to increase by 50 per cent by 2020 and place increased pressure on an already stressed health system. Non-drug therapy, such as education and exercise, has proven effective in helping people deal more effectively in managing knee osteoarthritis, particularly when they are diagnosed in an early stage of the disease. Unfortunately, many individuals remain undiagnosed for their condition and do not receive appropriate interventions.

In a previous study, this research team demonstrated that community pharmacists, using a simple screening questionnaire, could identify people with undiagnosed OA affecting the knee. For this current study, the researchers have designed a multi-disciplinary intervention in which pharmacists will identify individuals with likely OA, evaluate their prescription and over-the-counter medication use, refer them to a comprehensive treatment program involving physiotherapists at the provincial arthritis centre, and engage input and communication from their family doctors.

The team will measure the outcomes and cost-effectiveness of this education, assessment and referral intervention program to determine if, and to what extent, quality of care and health outcomes can be improved for individuals with previously undiagnosed knee OA. If successful, this multi-disciplinary health delivery model may also be useful for assisting in the management of other chronic diseases.

Research Results

This trial used a cluster randomized, controlled trial design, with pharmacies randomized to provide the intervention or usual care. The outcome assessors were blinded to the intervention status of the subject. Using our validated criteria to identify those with undiagnosed knee osteoarthritis (OA) by pharmacists, participants were recruited from study pharmacies. The intervention group was offered education, counseling, medication management, communication with the primary care physician and a physiotherapist guided exercise program. The usual care group received an educational pamphlet about OA. The primary outcome measure was the Arthritis Foundation Quality Indicators (QI) for the Management of Osteoarthritis. Secondary outcomes included the WOMAC and the Lower Extremity Function Scale (LEF). Multilevel models, also referred to as hierarchical linear models and random coefficient models, were used to appropriately model participant-level and pharmacy-level covariates simultaneously. We developed a two-level hierarchical model for the primary outcome, while a three-level hierarchical model was used for the secondary outcomes, due to the longitudinal nature of the data.

32 pharmacies participated in the trial with 71 and 65 participants in the intervention and control arms, respectively. Participants were mostly female (56%), mean age of 62 years (SD=10.5). The body mass index (BMI) was classified as normal (18.5 – 24.9) in 35%; overweight (25.0-29.9) in 38%; and obese (>30.0) in 25%. At 6 months the QI pass rate was significantly higher for those in the intervention arm compared to the control arm (diff=61%, 95% CI (52.1, 70.2), p<0.0001). Significant improvements occurred in the WOMAC total, pain and function scores (all p<0.01), the PAT-5D pain and daily activity scores (both p<0.05) and the LEF (p=0.012).

The study showed that a multidisciplinary intervention initiated by pharmacists that also involved family practitioners and physiotherapists improved the quality of care for knee osteoarthritis over six months. This improvement in care was accompanied by a reduction in participants’ pain and improvement in functional ability.