Background Osteoarthritis of the knee is a very common disease, and gains importance because of the aging population and the obesity epidemic1. Guidelines on the treatment and management of patients with knee osteoarthritis are widely available. Yet, knee osteoarthritis care in general practice has proved to be suboptimal2–4.
Objectives The aim of our study was to explore barriers and facilitators for guideline adherence in primary care. Part of the study specifically focused on barriers and facilitators with respect to the guidelines themselves.
Methods Two focus-groups were organized within local peer-groups of general practitioners using semi-structured interviews and a phenomenological approach to reach an in-depth understanding of general practitioners' lived experiences. Both focus-groups were audiotaped and written down literally. An existing framework5 was used in a non-restrictive way to code the individual quotes of the participants. The analyses were done by Nvivo10.
Results The local peer-groups were composed of 8 and 13 general practitioners, respectively. Both men and women were represented. The youngest participant was 24 years old; the oldest one 73. Practitioners from solo-, duo- and group practices were all involved. Dissemination of knee osteoarthritis guidelines turned out to be a main barrier. Most practitioners were not aware of guidelines regarding knee osteoarthritis. Local available guidelines in Dutch from Domus Medica, the Belgian scientific organization of general practitioners and from the Dutch College of General Practitioners were considered useful and convenient tools; yet, knee osteoarthritis care was not treated or only included in less specific guidelines. To stay up-to-date with new available evidence and guideline-updates it was considered useful to receive an e-mail message out of the local professional or scientific organizations with a link to the respective guidelines on their website. Also a direct link between the electronic patient file and evidence sources should be helpful in order to provide on-site information. Finally, a “general practice-oriented” approach of guidelines was considered important, as most guidelines do not focus on primary health care.
Conclusions International well-established guidelines about knee osteoarthritis care do not seem to reach general practice. Translation, transformation and adaptation to local general-practice oriented guidelines, provided by local professional and scientific organizations could favor dissemination in primary care. On-site information when registering knee osteoarthritis diagnosis in the electronic medical patient file could be helpful in the medical decision process.
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Denoeud et al. First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence Ann Rheum Dis 2005;64(1):70-4
Porcheret et al. Primary care treatment of knee pain-a survey in older adults Rheumatology (Oxford) 2007;46(11):1694-700
Li et al. Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis J Rheumatol 2011;38(10):2230-7
Van Den Boogaard et al. Identification of barriers for good adherence to a guideline on recurrent miscarriage Acta Obstet Gynecol Scand 2011;90(2):186-91
Disclosure of Interest None declared