Need for and receipt of hip and knee replacement—a national population survey

Steel, Nicholas; Melzer, David; Gardener, Elizabeth; McWilliams, Brenda

doi:10.1093/rheumatology/kel131

Cited by 58 publications

(52 citation statements)

References 29 publications

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“…[4][5][6] In contrast, this primary care-based study showed no variation in recorded offers of referral by deprivation status.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…The percentage of patients with osteoarthritis treated with an NSAID, whose notes contain a record that they RAND have been advised of the gastrointestinal and renal risks associated with this drug Regular assessment indicators 3 The percentage of patients treated for symptomatic osteoarthritis, whose notes contain a record that they RAND have been assessed for functional status in the last year 4 The percentage of patients treated for symptomatic osteoarthritis, whose notes contain a record that they RAND have been assessed for degree of pain in the last year 5 The percentage of patients with osteoarthritis regularly treated with an NSAID, whose notes contain a record RAND that they have been asked about gastrointestinal symptoms within the previous 12 months Treatment provision indicators 6 The percentage of patients in whom oral pharmacological therapy was initiated to treat osteoarthritis, RAND whose notes contain a record that they were offered paracetamol first (unless contraindicated) QIGP 7…”

Section: Derivation Of Quality Indicatorsmentioning

confidence: 99%

“…2 Osteoarthritis is an age-related condition, 3 and there is a greater level of need among women and those from more deprived backgrounds. 4 Those in poorer socioeconomic groups and women have higher levels of need for hip and knee replacement but receive relatively fewer joint replacements. [4][5][6] Many individuals are living for prolonged periods with severe osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

“…4 Those in poorer socioeconomic groups and women have higher levels of need for hip and knee replacement but receive relatively fewer joint replacements. [4][5][6] Many individuals are living for prolonged periods with severe osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

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Recorded quality of primary care for osteoarthritis: an observational study

et al. 2008

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INTRODUCTION Osteoarthritis causes substantial morbidity in developed countries. In the UK it is the most prevalent chronic disease among adults aged 65 years and over, affecting 32% of men and 47% of women.1 It is also the most common cause of disability.2 Osteoarthritis is an age-related condition,3 and there is a greater level of need among women and those from more deprived backgrounds.4 Those in poorer socioeconomic groups and women have higher levels of need for hip and knee replacement but receive relatively fewer joint replacements.4–6 Many individuals are living for prolonged periods with severe osteoarthritis. High-quality primary care is of clear importance for such a prevalent condition that has both major personal and social impact. This has been recognised by the National Institute for Health and Clinical Excellence (NICE), which has recently published guidelines for the care and management of osteoarthritis in adults.7 However, there is little published information on the quality of primary care for osteoarthritis in the UK. US studies have found the quality of osteoarthritis primary care to be suboptimal, with achievement of quality measures ranging from 31% to 64%.8 This study assessed the overall quality of recorded osteoarthritis treatment in primary care in an English county. It also assessed whether the recorded ABSTRACT Background Osteoarthritis is the most common chronic disease in the UK, with greater prevalence in women, older people, and those with poorer socioeconomic status. Effective treatments are available, yet little is known about the quality of primary care for this disabling condition. Aim To measure the recorded quality of primary care for osteoarthritis, and assess variations by patient and/or practice characteristics. Design of study Retrospective observational study. Setting Eighteen general practices in England. Method Records of 320/393 randomly selected patients with osteoarthritis (response rate 81%) were reviewed. High-quality health care was specified by nine quality indicators. Logistic regression modelling assessed variations in quality by age, sex, deprivation, severity, time since diagnosis, and practice size. Results There was substantial variation in the recorded achievement of individual indicators (range 5% to 90%). The percentage of eligible patients whose records show that they received care in the form of information provision ranged from 17% to 30%. For regular assessment indicators the range was 27% to 43%, and for treatment indicators the range was 5% to 90%. Recorded achievement of quality indicators was higher in those with more severe osteoarthritis (odds ratio [OR] 1.38, 95% CI = 1.13 to 1.69) and in older patients (OR 1.14, 95% CI = 1.02 to 1.28). There were no significant variations by deprivation score. Conclusion This study has demonstrated the feasibility of using existing robust quality indicators to measure the quality of primary care for osteoarthritis, and has found considerable scope for improvement in the recording of high-quality care. The...

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“…[4][5][6] In contrast, this primary care-based study showed no variation in recorded offers of referral by deprivation status.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Derivation Of Quality Indicatorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recorded quality of primary care for osteoarthritis: an observational study

et al. 2008

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“…45 It defines angina according to standard criteria as chest pain or discomfort that fulfils all of the following criteria:…”

Section: Rose Angina Scalementioning

confidence: 99%

The dynamics of quality: a national panel study of evidence-based standards

Hardcastle

Mounce

Richards

et al. 2015

Health Services and Delivery Research

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BackgroundShortfalls in the receipt of recommended health care have been previously reported in England, leading to preventable poor health.ObjectivesTo assess changes over 6 years in the receipt of effective health-care interventions for people aged 50 years or over in England with cardiovascular disease, depression, diabetes or osteoarthritis; to identify how quality varied with participant characteristics; and to compare the distribution of illness burden in the population with the distributions of diagnosis and treatment.Setting and participantsInformation on health-care quality indicators and participant characteristics was collected using face-to-face structured interviews and nurse visits in participants’ homes by the English Longitudinal Study of Ageing in 2004–5, 2006–7, 2008–9 and 2010–11. A total of 16,773 participants aged 50 years or older were interviewed at least once and 5114 were interviewed in all four waves; 5404 reported diagnosis of one or more of four conditions in 2010–11.Main outcome measuresPercentage of indicated health care received by eligible participants for 19 quality indicators: seven for cardiovascular disease, three for depression, five for diabetes and four for osteoarthritis, and condition-level quality indicator achievement, including achievement of a bundle of three diabetes indicators.AnalysisChanges in quality indicator achievement over time and variations in quality with participant characteristics were tested with Pearson’s chi-squared test and logistic regression models. The size of inequality between the hypothetically wealthiest and poorest participants, for illness burden, diagnosis and treatment, was estimated using slope indices of wealth inequality.ResultsAchievement of indicators for cardiovascular disease was 82.7% [95% confidence interval (CI) 79.9% to 85.5%] in 2004–5 and 84.2% (95% CI 82.1% to 86.2%) in 2010–11, for depression 63.3% (95% CI 57.6% to 69.0%) and 59.8% (95% CI 52.4% to 64.3%), for diabetes 76.0% (95% CI 74.1% to 77.8%) and 76.5% (95% CI 74.8% to 78.1%), and for osteoarthritis 31.2% (95% CI 28.5% to 33.8%) and 35.6% (95% CI 34.2% to 37.1%). Achievement of the diabetes care bundle was 67.8% (95% CI 64.5% to 70.9%) in 2010–11. Variations in quality by participant characteristics were generally small. Diabetes indicator achievement was worse in participants with cognitive impairment [odds ratio (OR) 0.5, 95% CI 0.4 to 0.7] and better in those living alone (OR 1.7, 95% CI 1.3 to 2.0). Hypertension care was better for those aged over 74 years (vs. 50–64 years) (OR 3.2, 95% CI 2.0 to 5.3). Osteoarthritis care was better for those with severe (vs. mild) pain (OR 1.8, 95% CI 1.4 to 2.2), limiting illness (OR 1.8, 95% CI 1.5 to 2.1), and obesity (OR 1.6, 95% CI 1.2 to 2.0). Previous non-achievement of the diabetes care bundle was the biggest predictor of non-achievement 2 years later (OR 3.3, 95% CI 2.2 to 4.7). Poorer participants were always more likely than wealthier participants to have illness burden (statistically significant OR 3.9 to 16.0), but not always more likely to be diagnosed or receive treatment (0.2 to 5.3).ConclusionsShortfalls in quality of care for these four conditions have persisted over 6 years, with only half of the level of indicated health care achieved for osteoarthritis, compared with the other three conditions. Quality for osteoarthritis improved slightly over time but remains poor. The relatively high prevalence of specific illness burden in poorer participants was not matched by an equally high prevalence of diagnosis or treatment, suggesting that barriers to equity may exist at the stage at diagnosis. Further research is needed into the association between quality and health system characteristics at the level of clinicians, general practices or hospitals, and regions. Linkage to routinely collected data could provide information on health service characteristics at the individual patient level.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Prevalence of Knee and Hip Osteoarthritis and the Appropriateness of Joint Replacement in an Older Population

Quintana¹

2008

Arch Intern Med

242

146

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Background: Relatively little is known about the prevalence of knee and hip osteoarthritis in the general population. Methods: To estimate the prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in a general population of older individuals, the validated Knee and Hip OsteoArthritis Screening Questionnaire (KHOA-SQ) was sent to a random sample of individuals aged 60 to 90 years, stratified by age and sex, living in a single province in Spain. Respondents positive for knee or hip osteoarthritis on the KHOA-SQ were invited to be examined by an orthopedic surgeon. Diagnosis of knee or hip osteoarthritis was based on clinical and radiographic data. For respondents judged as having osteoarthritis, the appropriateness of knee or hip replacement was evaluated using published explicit criteria. Results: Of 11 002 individuals contacted, 7577 completed the KHOA-SQ. The derived prevalence of hip osteoarthritis was approximately 7.4%. It was slightly higher in women (8.0%) than in men (6.7%) and tended to increase with age. The estimated appropriateness rate for hip replacement was 37.7% in men and 52.7% in women with osteoarthritis. The derived prevalence of knee osteoarthritis was 12.2%; it was significantly higher in women (14.9%) than in men (8.7%) and tended to increase with age. The estimated appropriateness rate for knee replacement was 11.8% in men and 17.9% in women with osteoarthritis. Conclusions: Knee and hip osteoarthritis are highly prevalent diseases in the older population. The estimation of appropriateness for hip replacement seems to be significantly higher than that for knee replacement.

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Need for and receipt of hip and knee replacement—a national population survey

Cited by 58 publications

References 29 publications

Recorded quality of primary care for osteoarthritis: an observational study

Recorded quality of primary care for osteoarthritis: an observational study

The dynamics of quality: a national panel study of evidence-based standards

Prevalence of Knee and Hip Osteoarthritis and the Appropriateness of Joint Replacement in an Older Population

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