Background Recently, a stepped care strategy presenting the optimal order of conservative treatment options for osteoarthritis (OA) of the hip or knee has been developed.1 It suggests in three steps that more advanced options should only be considered if the options tried initially lead to insufficient results. The first step consists options which could also be provided through self care (like education and paracetamol) whereas the second and third step comprise more advanced options (like physical therapy and NSAIDs).
Objectives In the light of a covering study that aims to implement this stepped care strategy, we considered it important to gain more insight in the collaboration of general practitioners (GPs) with other professionals and their beliefs and policy regarding the efficacy and timing of the treatment options in OA.
Methods A survey was sent to a random sample of GPs in the Netherlands (n=1224). GPs were asked about their collaboration with specific professionals (e.g. practice nurses, physical therapists, and medical specialists) in their OA management. Beliefs about the efficacy and timing of different treatment options were compared with recommendations of the stepped care strategy. GPs’ actual management was assessed with questions about their policy regarding referrals and prescriptions of drugs based on their last consultation with a patient with early symptoms of hip or knee OA.
Results 456 GPs (37%), aged 30-65 years and 67% male, responded to the questionnaire. According to 17% of the GPs their practice nurse played a role in the treatment of OA. 77% reported to have no structural collaboration with other professionals. Almost half of the GPs reported to have incidental contact (once a month to once a week) with a physical therapist to discuss the treatment of one or more individual OA patients. Incidental contact with a dietician, rheumatologist and orthopaedic surgeon, was reported by 3%, 8%, and 14% of the GPs respectively.
In general, GPs’ beliefs about the timing and efficacy of the different treatment options were in concordance with the stepped care strategy. Most GPs underlined the importance of education and lifestyle advice (87% and 86% respectively). Half of the GPs provided these options to a patient with early symptoms. More advanced options, like physical therapy, NSAIDs, and refferal to an orthopaedic surgeon, were also frequently provided (55%, 40%, and 23% respectively).
Conclusions No barriers with respect to the collaboration of GPs, their beliefs and policy regarding OA management were identified that could interfere with the implementation of the stepped care strategy. However, some discrepancies were found between the actual OA management and recommendations of the stepped care strategy.
Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, Voorn TB, Schers HJ, Bierma-Zeinstra SM, Dekker J. “Beating osteoARThritis”: development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clinical Rheumatology, 2011;30:1623-9.
Disclosure of Interest None Declared