Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study

Smink, A.; Bierma-Zeinstra, Sita M A; Dekker, Joost; Vlieland, Thea Vliet; Bijlsma, J. W. J.; Swierstra, Bart A; Kortland, Joke H.; Voorn, Th.B.; Ende, C.H.M. van den; Schers, Henk

doi:10.1186/1471-2296-14-33

Cited by 23 publications

(14 citation statements)

References 27 publications

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“…This prescription behaviour has previously been indicated in an observational study by Cardol et al [ 14 ]. Moreover, a more recent study investigating GPs’ attitudes regarding SCS recommendations, showed that 21% of the GPs (strongly) agree with the statement ‘NSAIDs should be the first choice of pain medication in patients with OA’ [ 15 ]. Given the recognized increased risk of several adverse outcomes in older adults due to the frequent use of NSAIDs and to improve guideline adherence, GPs could be advised to optimize the analgesics policy prior to consider NSAIDs prescription in patients with hip/knee OA [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

et al. 2015

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BackgroundA multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy.MethodsData were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy.ResultsContent of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients.ConclusionIn accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0295-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

et al. 2015

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“…GPs received 2 questionnaires: a short baseline questionnaire to assess demographics and practice characteristics and a second questionnaire that was based on a cross‐sectional study of GPs' agreement with the SCS (). In this study, we collected data regarding their organization of OA care and attitudes about OA management and the SCS.…”

Section: Methodsmentioning

confidence: 99%

Health Care Use of Patients With Osteoarthritis of the Hip or Knee After Implementation of a Stepped‐Care Strategy: An Observational Study

Smink

Dekker

Vlieland

et al. 2014

Arthritis Care & Research

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Objective. To enhance guideline-based nonsurgical management of osteoarthritis (OA), a multidisciplinary stepped-care strategy has been implemented in clinical practice. This study aimed to describe health care use after implementation of this strategy and to identify factors related to such use at multiple levels. Methods. For this 2-year observational prospective cohort, patients with symptomatic hip or knee OA were included by their general practitioner. Activities aligned with patients and health care providers were executed to implement the strategy. Health care use was described as the cumulative percentage of "users" for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Results. Three hundred thirteen patients were included by 70 general practitioners of 38 practices. Their mean ؎ SD age was 64 ؎ 10 years and 120 (38%) were men. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients, respectively. Fourteen percent of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis," and having limitations in functioning were recurrently identified as determinants of health care use. Conclusion. After implementation of the stepped-care strategy, most recommended nonsurgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more efforts to encourage patients with a passive coping style to use nonsurgical modalities.

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“…Evidence based clinical guidelines have been published to improve clinical decision making by healthcare professionals managing lower limb osteoarthritis (Larmer, Reay, Aubert, and Kersten, 2014). Similar guidelines have been adopted and supported by GPs in the Netherlands (Smink et al, 2013), but for the GPs in this study they appear to be underutilised and to be seen to act as a brake on clinical autonomy.…”

Section: Discussionmentioning

confidence: 87%

Views of general practitioners toward physiotherapy management of osteoarthritis—a qualitative study

Okwera

May

2018

Physiotherapy Theory and Practice

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Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study

Cited by 23 publications

References 27 publications

Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

Health Care Use of Patients With Osteoarthritis of the Hip or Knee After Implementation of a Stepped‐Care Strategy: An Observational Study

Views of general practitioners toward physiotherapy management of osteoarthritis—a qualitative study

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