Table 1 MOSAICS study context

Overview

MOSAICS was an investigation of the feasibility, acceptability and impact of implementing the National Institute for Health and Care Excellence (NICE) osteoarthritis (OA) Guideline [16]. MOSAICS was informed by the NICE guidelines (NICE 2008, updated 2014) [17] and the intervention development was guided by theory and shaped by clinical and academic stakeholders and public contributors [18, 19].

The aim of MOSAICS was to evaluate the clinical and cost-effectiveness of a ‘model OA consultation’—a complex intervention designed to increase adherence to national guidelines for OA management in primary care.

Theoretical approaches used to inform MOSAICS:

•Implementation of Change model [20] to guide the overall approach. The model comprises five steps: developing a concrete proposal for change; undertaking an analysis of current practice; developing and selecting ways to change practice and undertaking and evaluating the implementation plan

•The Theoretical Domains Framework [21] consists of 12 domains and was used to identify relevant domains of behaviour change and to understand which factors would impede or facilitate the intended healthcare professional behaviour change.

•The Whole Systems Informing Self-management Engagement (WISE) approach underpinned the development of the MOSAICS model [22]: relevant and accessible patient information, professionals responsive to the needs of patients and good access to care services.

Context

A mixed methods research study incorporating a population survey, cluster randomised controlled trial, consultation, and medical record review, and an evaluation of a model OA consultation intervention and training, conducted in general practice primary care in England

Innovation

Components of the trial intervention:

i) An OA Guidebook written by patients and health professionals for patients to provide patient-centred and evidence-based information

ii) A model OA consultation for primary care to deliver NICE interventions for people aged 45 years or older presenting to the practice with peripheral joint pain

iii) Training for GPs and practice nurses to deliver the model consultation

iv) The development and capture of quality indicators of care (through an OA e-template and self-reported questionnaire)

The MOSAICS model consisted of three components: (i) an initial consultation with a GP, followed by (ii) up to four consultations with a practice nurse in an OA clinic, with (iii) the Keele OA Guidebook to support care. The evidence-based intervention was designed to provide relevant written information for patients, along with support in undertaking muscle strengthening exercises, increase physical activity and weight loss (if appropriate).

Recipients

GPs and practice nurses in general practices involved in the trial

Facilitation

Components of the training package delivered in the MOSAICS trial [18, 19]:

Theoretical approach: Training package development informed by the Theoretical Domains Framework

Content: Provided information on establishing the current practice, core NICE recommendations for OA (diagnosis, written information [the OA guidebook], exercise and physical activity, healthy eating, pain management), history taking and self-management support

Delivery: Training incorporating a mixture of didactic and interactive sessions (including the use of simulated patients) which were learner centred and facilitated by local opinion leaders.

Duration of training for intervention practices: GP training - four sessions (2 h ×3, 1 h ×1). Practice nurse training – 4 days

Duration of training for control practices: Three sessions over a 3-week period, after completion of trial. The first two sessions of GP training comprised 2× lunchtime sessions and for Practice nurses, 2× 1-day workshops. The final session for all staff was a focus group discussion with the whole practice, led by a facilitator who had been involved in MOSAICS as a rheumatology advisor.