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OP0201-PC Agreement of General Practitioners with the Guideline-Based Stepped-Care Strategy for Patients with Osteoarthritis of the Hip or Knee: A Cross-Sectional Study
  1. A. Smink1,
  2. S. Bierma Zeinstra2,
  3. J. Dekker3,
  4. T. Vliet-Vlieland4,
  5. J. Bijlsma5,
  6. B. Swierstra6,
  7. J. Kortland7,
  8. T. Voorn8,
  9. C. van den Ende1,
  10. H. Schers8
  1. 1Rheumatology, Sint Maartenskliniek, Nijmegen
  2. 2General practice and Orhopaedics, University Medical Center, Rotterdam
  3. 3Rehabilitation Medicine, VU University Medical Center, Amsterdam
  4. 4Rheumatology and Orthopaedics, Leiden University Medical Center, Leiden
  5. 5Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
  6. 6Orthopaedics, Sint Maartenskliniek, Nijmegen
  7. 7Dutch patient organization for rheumatic diseases, Amersfoort
  8. 8Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands


Background To improve the management of hip or knee osteoarthritis (OA), a multidisciplinary guideline-based stepped-care strategy (SCS) with recommendations regarding the appropriate non-surgical treatment modalities and optimal sequence for treatment has been developed.(1) Implementation of this SCS in the general practice may be hampered by the negative attitude of general practitioners (GPs) towards the strategy. In order to develop a tailored implementation plan, we assessed the GPs’ views regarding specific SCS recommendations and their working procedures with regard to OA.

Objectives The objectives of this study are 1) to describe GPs’ attitudes with respect to two key elements of the SCS, i.e. effectiveness of non-surgical treatment modalities and the optimal sequence for treatment and 2) to identify factors that could influence GPs’ agreement regarding SCS recommendations.

Methods A survey was conducted among a random sample of Dutch GPs. Questions included the GP’s demographical characteristics and practice setting, as well ass how the management of OA was organized and whether the GPs supported SCS recommendations. In particular, we assessed GP’s views regarding the effectiveness of 14 recommended and non-recommended treatment modalities. Furthermore, we calculated their agreement with 7 statements based on SCS recommendations regarding the sequence for treatment. With a linear regression model, we identified factors that seemed to influence the GPs’ agreement with SCS recommendations.

Results Four hundred fifty-six GPs (response rate 37%) aged 30-65 years, of whom 278 males (61%), responded. Seven of the 11 recommended modalities (i.e. oral NSAIDs, physical therapy, glucocorticoid intra-articular injections, education, lifestyle advice, acetaminophen, and tramadol) were considered effective by the majority of the GPs (varying between 60-95%). The mean agreement score, based on a 5-point scale, with recommendations regarding the sequence for treatment was 2.8 (SD=0.5). Ten percent of the variance in GPs’ agreement could be explained by GPs’ attitudes regarding the effectiveness of recommended and non-recommended non-surgical treatment modalities and the practice type.

Conclusions In general, GPs support the SCS recommendations. Therefore, weexpect that their attitudes will not impede a successful implementation in general practice. Our results provide several starting points on which to focus implementation activities for specific SCS recommendations; those related to the prescription of pain medication and the use of X-rays. We could not identify factors that contribute substantially to GPs’ attitudes regarding SCS recommendations about the sequence for treatment.


  1. 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

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