GP referral of patients with osteoarthritis for consideration of total joint replacement: a longitudinal study

Abstract

METHOD Participants and samplingThis was a longitudinal study with data collected by postal questionnaire at baseline, 3 months, 6 months, and 12 months. This paper reports on baseline and 12 month data. All new GP referral letters to 10 orthopaedic surgeons in a regional orthopaedic centre in the north west of England were read on a weekly basis, to identify individuals over 18 years of age with a confirmed diagnosis of OA who were considered potentially suitable for TJR. A patient-recruitment form was used to record patient information details and the reason for referral. Recruitment of AimThe aim of the study was to investigate symptom variation in individuals with OA newly referred by GPs to an orthopaedic surgeon for consideration for TJR, and to determine the predictors of having this procedure. Design and settingA longitudinal study of patients at a regional orthopaedic centre with follow-up at 3, 6, and 12 months by postal questionnaire. MethodGP referrals of patients with OA to orthopaedic surgeons were consecutively sampled. Of the 431 eligible patients, 257 (59.6%) were recruited. Validated measurement tools were used to measure pain, physical functioning, severity of OA, and health-related quality of life.

The development and validation of a multivariable model to predict whether patients referred for total knee replacement are suitable surgical candidates at the time of initial consultation

“…8 Interestingly, current evidence suggests that nearly 50%-70% of patients referred to an orthopedic surgeon for TKR are not scheduled for surgery. 9,10 In a public health care system, ensuring that patients are seen by the appropriate specialist at the right time is key to ensure efficient allocation of health care resources and timely access to care.…”

The CanPain SCI Clinical Practice Guideline for Rehabilitation Management of Neuropathic Pain after Spinal Cord: recommendations for model systems of care

“…As well as requesting a specialist referral, patients may also be required to facilitate the communication process between primary care physicians and pain centres/clinics. Poor communication between healthcare services frequently exists (see Chapter 11) and it may take weeks for the results of a specialist appointment to be communicated to the primary care physician [Piterman & Koritsas 2005;McHugh et al 2011;Raza et al 2011]. The patient also plays an important role in helping the primary care physician make an appropriate referral.…”

Managing osteoarthritis in primary care: the GP as public health physician and surgical gatekeeper

“…The two papers reported in this issue of the Journal 5,6 point to an expanding evidence base that rejects the idea that primary care for osteoarthritis is about waiting until it is time to refer for a joint replacement. Not only are there simple positive approaches to reduce joint pain and disability in older people, but joint replacements, valuable and important as they are, will not be needed or wanted by everyone with osteoarthritis, and remain in need of a better evidence base to clarify optimal patient selection and timing of surgery.…”

“…The topic of McHugh et al's paper 5 takes us to the other end of the spectrum and provides a description of the people whom GPs refer to surgeons for an opinion on joint replacement and what happens to them. The researchers found that only a minority of persons referred had a joint replacement in the following 12 months although, reassuringly, this minority were likely to have had more severe pain and more disability when referred than those who did not subsequently have an operation.…”

“…Yet there is evidence that many patients are not being offered the core treatments in primary care, 4 that surgeons continue to offer treatments that have no evidence base, 5 and that disability levels in the older population have not been shifted by joint replacement surgery. Two papers in this issue of the British Journal of General Practice 5,6 neatly highlight that a straightforward separation of patients into 'give this person with mild symptoms the core advice' and 'send this person with severe symptoms to the orthopaedic surgeon' may not have the intended results. Life is not quite as simple as that.…”