Australian GP management of osteoarthritis following the release of the RACGP guideline for the non-surgical management of hip and knee osteoarthritis

Abstract

BackgroundOsteoarthritis (OA) is a highly disabling and costly condition with an escalating prevalence in Australia due to the ageing and increasing obesity of the population. The general practitioner (GP) plays a central role in the management of this condition. The aim of this study was to examine opinions about the management of OA by Australian GPs following the release of the Royal Australian College of General Practitioners Guideline for the non-surgical management of hip and knee OA (RACGP OA CPG), and to compare the results with an earlier survey administered by the National Prescribing Service.MethodsIn January 2013, a self-administered questionnaire was sent to 228 GPs to determine their treatment approaches to OA management using a clinical vignette of a patient with OA. This was compared with results from a similar survey undertaken in 2006.ResultsSeventy-nine GPs returned questionnaires (response rate 35 %). GP recommendations for paracetamol, a paracetamol/codeine compound, and oral non-steroidal anti-inflammatory drugs (NSAIDs) were consistent with recommendations in the RACGP OA CPG, and varied little from the previous survey. Notably, there was a marked increase between surveys in GP recommendations for tramadol (p = 0.004) and more potent opioids (p < 0.001). Advice about the adverse effects of NSAIDs and codeine and how to manage them increased between surveys (p = 0.038 and 0.005, respectively). For all non-pharmacological treatments, there were only minor changes in the percentage of GP recommendations when compared with the previous survey, however they remain underutilised.ConclusionsGPs generally demonstrated a conservative approach to the treatment of OA, however, the increased recommendations for more potent opioids warrants further investigation. Patients should be made aware of the risks of medications through the use of decision aids, which can provide structured guidance to treatment. Non-pharmacological interventions were not given the importance that is suggested by clinical practice guidelines.

Mechanism of Salviae Miltiorrhizae Radix et Rhizoma in the treatment of knee osteoarthritis based on network pharmacology

“…Existing studies have shown that SMRR not only can prevent OA cartilage degeneration through antioxidative stress but can also reduce OA cartilage damage and thus be used to treat OA [20,28]. The effective active SMRR component-target gene relationship network showed that the treatment of OA by SMRR is achieved through multiple components, multiple pathways, and multiple targets.…”

“…Studies have shown that, in abnormal circumstances, SMRR can interfere with OS [18,19]. It has been claimed that SMRR can prevent articular cartilage degeneration in OA rabbits by inhibiting OS [20]. In addition, SMRR can alleviate OA by inhibiting NF-κB signal transduction and regulating the JAK2/STAT3 and AKT signal transduction pathways [21].…”

Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients

“…The impact of these guidelines on the prescribing practices of general practitioners, where the majority of prescribing in Australia occurs, has yet to be elucidated. Following the release of the 2009 guidelines an increase in prescribing of potent opioids to future TJR patients was observed for reasons that remain unclear. Utilization of non‐pharmacological treatments including physiotherapy and weight loss as first‐line strategies are low compared to pharmacological management rates for osteoarthritis .…”

General practitioners’ perspectives on a proposed new model of service delivery for primary care management of knee osteoarthritis: a qualitative study

“…In most countries, people with knee OA are managed predominantly in primary care by their GP or family doctor [ 9 ]. Optimal care requires patients to be empowered to self-manage with lifestyle interventions that require long-term behavioural change, which creates additional management challenges for GPs [ 10 , 11 ]. Unsurprisingly, current management of the condition can be variable and is often inconsistent with recommended practice [ 3 , 11 , 12 ].…”

“…Optimal care requires patients to be empowered to self-manage with lifestyle interventions that require long-term behavioural change, which creates additional management challenges for GPs [ 10 , 11 ]. Unsurprisingly, current management of the condition can be variable and is often inconsistent with recommended practice [ 3 , 11 , 12 ]. Studies from many parts of the world reveal over-reliance on imaging and drugs compared with self-management and lifestyle options [ 13 ], and referrals to orthopaedic surgeons can be higher than referrals for exercise [ 13 ].…”