Health professionals and students encounter multi-level barriers to implementing high-value osteoarthritis care: a multi-national study

A. M. Briggs, E. Houlding, R. S. Hinman, L. A. Desmond, K. L. Bennell, B. Darlow, T. Pizzari, M. Leech, C. MacKay, P. J. Larmer, A. Bendrups, A. M. Greig, A. Francis-Cracknell, J. E. Jordan, H. Slater

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)


Objective: Consistent evidence-practice gaps in osteoarthritis (OA) care are observed in primary care settings globally. Building workforce capacity to deliver high-value care requires a contemporary understanding of barriers to care delivery. We aimed to explore barriers to OA care delivery among clinicians and students. Design: A cross-sectional, multinational study sampling clinicians (physiotherapists, primary care nurses, general practitioners (GPs), GP registrars; total possible denominator: n = 119,735) and final-year physiotherapy and medical students (denominator: n = 2,215) across Australia, New Zealand and Canada. Respondents answered a survey, aligned to contemporary implementation science domains, which measured barriers to OA care using categorical and free-text responses. Results: 1886 clinicians and 1611 students responded. Items within the domains ‘health system’ and ‘patient-related factors’ represented the most applicable barriers experienced by clinicians (25–42% and 20–36%, respectively), whereas for students, ‘knowledge and skills’ and ‘patient-related factors’ (16–24% and 19–28%, respectively) were the most applicable domains. Meta-synthesis of qualitative data highlighted skills gaps in specific components of OA care (tailoring exercise, nutritional/overweight management and supporting positive behaviour change); assessment, measurement and monitoring; tailoring care; managing case complexity; and translating knowledge to practice (especially among students). Other barriers included general infrastructure limitations (particularly related to community facilities); patient-related factors (e.g., beliefs and compliance); workforce-related factors such as inconsistent care and a general knowledge gap in high-value care; and system and service-level factors relating to financing and time pressures, respectively. Conclusions: Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).

Original languageEnglish
Number of pages17
JournalOsteoarthritis and Cartilage
Publication statusPublished - 19 Jan 2019


  • Implementation
  • Interprofessional
  • Service delivery
  • System

Cite this

Briggs, A. M., Houlding, E., Hinman, R. S., Desmond, L. A., Bennell, K. L., Darlow, B., Pizzari, T., Leech, M., MacKay, C., Larmer, P. J., Bendrups, A., Greig, A. M., Francis-Cracknell, A., Jordan, J. E., & Slater, H. (2019). Health professionals and students encounter multi-level barriers to implementing high-value osteoarthritis care: a multi-national study. Osteoarthritis and Cartilage.