Background Evidence-based recommendations for management of osteoarthritis (OA) have been developed to improve the quality of care by promoting interventions of proven benefit and discouraging ineffective interventions. There is remarkable consistency between different international and national guidelines for management of hip and knee OA, but it is not clear to what degree clinical practice in primary care reflect these recommendations.
Objectives To present an overview of published studies comparing general practitioners actual practice with desired practice for patients with hip and knee OA
Methods Within the framework of a systematic review, we considered studies that assessed the care provided to patients with hip or knee OA in primary care or in a community setting, against an explicitly described standard as eligible for inclusion. Studies that used clinical vignettes or hypothetical patients were not included. We searched Medline, Embase and AMED for the years 2000 to 2011, and tracked the reference lists of included studies. Two authors independently scanned titles and abstracts, and assessed the full text articles before inclusion. Data was extracted by one author and checked by a second author. A qualitative data synthesis was performed.
Results The literature searches identified 599 hits, and 10 studies met the inclusion criteria. The ACR- or Eular guidelines or quality indicators (QI) derived from RAND or NICE were most frequently used as standards for benchmarking. Three studies from UK and USA (n=2) examined the quality of care for a broad array of diagnoses, and found that adherence to QIs for OA were 57%, 31% and 29%, which were lower than adherence rates for most other conditions. Seven studied from the UK (n=2), Canada (n=2), Italy, USA and France investigated physicians’ management of more than 30.000 OA patients. Data were collected by patient- or provider reporting or by medical records. There was substantial variation in the recorded achievement of individual indicators ranging from 5% to 90%. All seven studies found that the quality of osteoarthritis care was suboptimal, and that there is a considerable scope for improvement. Four of the studies reported that especially the non-pharmacological care could be improved by more frequently providing information, advice on exercise and weight management. One study found the quality suboptimal, particularly with regard to medication safety, and one found that the combination of pharmacological and non-pharmacological care was under-utilized.
Conclusions The present review suggests that adherence to QIs in primary care are lower for osteoarthritis than most other conditions, and that the quality of care can be substantially improved. Especially the quality of nonpharmacological care for people with knee/hip OA can be improved.
Disclosure of Interest None Declared
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