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THU0609 Regional differences in health care utilization in the khoala cohort, a french population based cohort of symptomatic knee and/or hip oa patients
  1. A--C Rat1,2,
  2. J-H Salmon3,
  3. A Saraux4,
  4. C Gard5,
  5. F Guillemin1,6,
  6. B Fautrel7
  1. 1Ea 4360 Apemac, Lorraine Université
  2. 2Rheumatology, CHRU Nancy, Nancy
  3. 3Rheumatology, CHU Reims, Reims
  4. 4Rheumatology, la Cavale blanche University, hospital and université de Bretagne occidentale, Brest
  5. 5Pharmacy, Pitié Salpetrière hospital, Paris
  6. 6CIC 1433 Epidémiologie clinique, Inserm, CHRU, Université de Lorraine, Nancy
  7. 7Rheumatology, Université Pierre et Marie Curie (UPMC)-Paris 6 GRC-UMPC 08 (EMOIS), Paris, France

Abstract

Background In hip and knee OA, one of the leading causes of global disability, recent population-based data of health care practices and utilization are scarce. Describing patterns of care of patients is important to adapt health care practices and guide interventions to optimize patients' use of health care services.

Objectives The aim of the project was to describe health care utilization and associated factors of a representative sample of patients with knee or hip symptomatic OA.

Methods The KHOALA cohort is a French population-based multicenter cohort of patients with symptomatic knee and/or hip OA, aged between 40 and 75 years old recruited between 2007 and 2009. The representativity of the cohort allows for generalizing the results

Results Among the 878 patients, 609 (69%) were women, 222 (25%) have hip OA, 607 (69%) knee OA and 49 (6%) both hip and knee OA. Groll comorbidity index (0–18) was 3.1 (1.6). Radiographic K&L grades 2, 3 and 4 were 69.8%, 26.1% and 4.1% for hip OA respectively and 44.5%, 30.3%, and 25.2% for knee OA.

In multivariate analyses, increased pain was independently associated with increased number of patients using pain killers (non-opioids and weak opioids), symptomatic slow-acting drugs or steroid injections but not NSAIDs. Increased age or being retired was associated with increased use of non-opioid drugs or decreased prescription of NSAIDs but not with opioid drugs. Weak opioid drugs were more frequently used by patients with low than high education and by those consulting a rheumatologist. The geographical effect was important, independently of the symptoms, with OR=0.3 (95% CI 0.2–0.7) and OR=0.5 (95% CI 0.2–0.9) for south vs north/east and west vs north/east respectively for weak opioids use with the same trend for non-opioids use. On the opposite, physiotherapy was more frequently prescribed in the south than in the north OR=2.1 (95% CI 1.3–3.5). More patients consulted a rheumatologist in large (>50,000) than small cities (<2,000) OR=2.8 (95% CI 1.6–5.1) but this was not the case for orthopedic surgeons consultations. Pain was not independently associated with consultations with the different health care professionals. Instead the number of patients consulting different health care professionals increased with functional impairment. Consulting an orthopedic surgeon was less frequent for patients with more comorbidities, retired, with decreased vitality or who also did not consult a rheumatologist.

Conclusions Even if symptoms and patients characteristics are strongly associated with treatments use and health care professional consultations, regional or rural vs cities differences are important independently of pain, function or other quality of life domains. Whether these differences are due to health care professional prescriptions or patients life style and behaviors are still to be explored.

Disclosure of Interest None declared

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