Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee

Mazzuca, Steven A.; Brandt, Kenneth D.; Katz, Barry P.; Dittus, Robert S.; Freund, Deborah A.; Lubitz, Robert M.; Hawker, Gillian; Eckert, G.

doi:10.1002/art.1790100503

Cited by 63 publications

(62 citation statements)

References 29 publications

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“…However, this limitation is probably not as significant as it would appear. Both surveys of the self-reported management practices (33) and a study of actual practice variations (22) show that very few primary care physicians recommend (and, therefore, have the opportunity to reinforce) nonpharmacologic treatment modalities to their patients with knee or hip OA. Skill in follow-through of self-care education in arthritis is probably uncommon in practice, as well.…”

Section: Discussionmentioning

confidence: 99%

“…Optimism concerning the prospects for spontaneous, widespread adoption of current OA guidelines must be tempered by the fact that nonpharmacologic management practices for OA are uncommon in contemporary primary care practice (22). An alternative to convincing generalist physicians to adopt an array of new management practices is to augment primary care resources so that self-care education for knee OA patients could be implemented, for example, by an arthritis nurse specialist whose feedback could then help the primary care physician focus on the salient, ongoing needs of patients.…”

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confidence: 99%

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Effects of self‐care education on the health status of inner‐city patients with osteoarthritis of the knee

Mazzuca

Brandt

Katz

et al. 1997

Arthritis & Rheumatism

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Objective. To evaluate a concise program of selfcare education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis (OA).Methods. An attention-controlled clinical trial; 211 inner-city patients with knee OA were assigned arbitrarily to education (E) or attention-control (AC) conditions. Group E received an individualized 30-60-minute educational intervention that emphasized nonpharmacologic management of joint pain, preservation of function by problem-solving, and practice of principles of joint protection. Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new selfcare activities. Group AC viewed a 20-minute standardized public education presentation on arthritis and received followup telephone calls (only to encourage continued participation in the study). Outcomes included the Health Assessment Questionnaire (HAQ) Disability and Discomfort Scales, 10-cm visual analog scales measuring knee pain at rest and while walking, and the Quality of Well-Being (QWB) scale. Assessments were made at baseline and at 4-month intervals for 1 year.Results. A total of 165 subjects (78%) completed all assessments. After control for baseline status, group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup (P C 0.05 for both). Effects were somewhat discordant. By 12 months, functional benefits had begun to wane, while the effect on resting knee pain had grown. The overall effects of education on walking knee pain,

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of self‐care education on the health status of inner‐city patients with osteoarthritis of the knee

Mazzuca

Brandt

Katz

et al. 1997

Arthritis & Rheumatism

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“…The effect sizes (11) for the studies presented under the miscellaneous intervention category (35)(36)(37)(38)(39)(40) ranged from 0.04 to 1.3 for the stiffness subscale, 0.0009 to 1.17 for the physical function subscale, and 0.06 to 1.19 for the global score. In the one study reporting stiffness subscale data, the effect size was 0.55 for the control group and 0.52 for the treatment group.…”

Section: Responsivenessmentioning

confidence: 99%

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties

McConnell¹,

Kolopack²,

Davis³

2001

Arthritis & Rheumatism

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567

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“…For example, outcomes of persons suffering a myocardial infarction vary according to whether the patient was admitted to the hospital by a generalist or a specialist (Jollis et al 1996). In contrast, among persons with symptoms of knee osteoarthritis, physician specialty and specific management practices seem not to account for variations in patient outcomes (Mazzuca et al 1997). Research on asthma patients suggests that treatment intensity may be greater for persons treated by specialists (Engel et al 1989).…”

Section: Brief Review Of Provider Specialty Impactmentioning

confidence: 99%

Provider type and depression treatment adequacy

Kniesner¹,

Powers²,

Croghan³

2005

Health Policy

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We investigate the effect of initial provider (primary care physician, psychiatrist, or nonphysician mental health specialist) on the adequacy of subsequent treatment for persons with depression. Our data are from MarketScan ® , a medical and pharmacy insurance claims database, which we use to estimate models of the likelihood of treatment for depression and the likelihood that any treatment received is adequate. Patients initially seeing psychiatrists are most likely to receive adequate treatment. Provider type has a statistically and medically significant effect on whether any treatment occurs but a smaller effect on treatment adequacy among treated patients.The results show the importance of provider type in treatment patterns, but the effects on patient outcomes are yet to be determined definitively.

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Comparison of general internists, family physicians, and rheumatologists managing patients with symptoms of osteoarthritis of the knee

Cited by 63 publications

References 29 publications

Effects of self‐care education on the health status of inner‐city patients with osteoarthritis of the knee

Effects of self‐care education on the health status of inner‐city patients with osteoarthritis of the knee

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties

Provider type and depression treatment adequacy

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