Intervention Trial in
Purpose: Previously we have shown that pharmacists can reliably identify people with undiagnosed knee OA. This trial was performed to determine if a multidisciplinary intervention initiated by pharmacists could improve the quality of care for OA. Methods: 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 OA by pharmacists, participants were recruited from study pharmacies. The intervention group were offered education, counseling, medication management, communication with the primary care physician and a PT 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 OA. 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.Results: 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). Conclusion: A pharmacist-initiated multidisciplinary strategy to improve the quality of care for knee OA improves care, function and pain.