Background To evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incorporate specialist services into general practice to prevent unnecessary referrals to hospitals. Methods We used a mixed methods approach including semi-structured interviews, patient experience questionnaires and data from medical records from three intermediate care projects. Semi-structured interviews were conducted with patients, general practitioners (GPs), orthopaedists and a healthcare manager in intermediate care. Satisfaction of patients who received intermediate care (n = 100) was collected using questionnaires. Referral data and healthcare consumption from medical records were collected retrospectively from KHOA patients before (n = 96) and after (n = 208) the implementation of intermediate care. Results GPs and orthopaedists in intermediate care experienced more intensive collaboration compared to regular care. This led to a perceived increase in GPs’ knowledge enabling better selection of referrals to orthopaedics and less healthcare consumption. Orthopaedists felt a higher workload and limited access to diagnostic facilities. Patients were satisfied and experienced better access to specialists’ knowledge in a trusted environment compared to regular care. Referrals to physiotherapy increased significantly after the implementation of intermediate care (absolute difference = 15%; 95% CI = 7.19 to 22.8), but not significantly to orthopaedics (absolute difference = 5.9%; 95% CI = -6.18 to 17.9). Conclusions Orthopaedists and GPs perceived the benefits of an intensified collaboration in intermediate care. Intermediate care may contribute to high quality of care through more physiotherapy referrals. Further research with longer follow-up is needed to confirm these findings and give more insight in referrals and healthcare consumption.

No abstract

No abstract

Results: Complete 12 and 26-week data were available for 89 and 66 participants respectively: mean age 67.1 years; 75% female; 14% waitlisted for total joint arthroplasty. Baseline PAM-13 was not significantly associated with pain (b¼0.10 (95%CI-0.12, 0.31) p¼0.50) or function (b¼0.08 (95%CI-0.11, 0.28), p¼0.40) at 12 weeks and there were no significant relationships at 26-weeks either. Employment status and TUG were independently associated with changes in 12-week WOMAC pain and function scores (tables 1 and 2). No variables were significantly associated with changes in 26-week WOMAC pain or function. Following 26-weeks of the OACCP, PAM-13 scores improved by 5.8 points (n¼ 66, 95%CI 1. 89, 9.78).Conclusions: This study suggests that PAM-13 may not be a useful tool to predict changes in symptoms following the OACCP. However, the significant improvement in mean PAM-13 scores demonstrated following the OACCP were encouraging given that the main aim of the program is to educate and support participants to self-manage their OA. Baseline TUG and employment status were significantly associated with changes in pain and function. These variables should be examined further as potential predictors of outcomes of OAMPs.

No abstract