Background To improve the management of hip or knee osteoarthritis (OA), a patient-centred stepped-care strategy (SCS) has been developed that presents the optimal sequence for care in three steps. At each step, recommendations for diagnostic procedures, non-surgical treatment modalities and length of treatment before evaluation are made.1 This SCS defines the sequence for care as ‘optimal’ if all (advised) modalities in the previous steps have been offered to the patient before the more advanced modalities in the subsequent steps. A comprehensive insight in the sequence for care can provide starting points to develop and improve strategies to implement the SCS in clinical practice.
Objectives To describe the health care use and sequence for care in patients with hip or knee OA after implementation of the SCS in a region of the Netherlands. These results will be used to identify factors that influence the success of the implementation in order to implement the SCS nation wide.
Methods For this 2-year observational prospective cohort, general practitioners (GPs) were invited to implement the SCS and recruit patients with (symptomatic) hip or knee OA. Several implementation activities, aligned to patients and health care providers, were developed and executed. Patients completed questionnaires on health care use at baseline and every 6 months follow-up. To describe the health care use, we calculated the cumulative percentage ‘users’ for each treatment modality. The sequence for care is described by the number of patients that have been offered the advised modalities in the previous steps of the SCS before one or more advanced modalities in the subsequent steps.
Results In total, 313 patients were included in the study aged 64 years (SD=10), of whom 120 (38%) male, by 70 GPs out of 38 general practices. After 2 years, acetaminophen, education, lifestyle advice, physical therapy, and Non-steroidal Anti-Inflammatory Drugs or tramadol were used most frequently, 248 (82%), 241 (82%), 214 (73%), 184 (64%), 162 (57%) respectively. Out of the 237 patients that received at least one step-2 modality during the study period, 129 (57%) received all three advised step-1 modalities prior this step-2 modality. Out of the 82 patients who received at least one step-3 modality, 22 (29%) received all six advised step-1 and step-2 modalities prior to this step-3 modality.
Conclusions Our results show that step-1 modalities are more frequently offered to patients with (symptomatic) hip or knee OA during the first two years after consulting their GP with hip or knee complaints than step-2 or step-3 modalities as recommended in the SCS. However, our data might suggest that the use of treatment modalities proposed in step 1 and 2 could be further optimized, prior to the use of advanced modalities.
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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