Background People with arthritis in the UK can obtain significant health benefits from attendance at a lay-led arthritis self management programme.¹ We have found significant improvements in knowledge relevant to self-management following attendance at a nurse-led community-based osteoarthitis (OA) education programme and an 82% reduction in OA-related visits to the GP in the 12 months following.² It was envisaged that there could be substantial benefits to quality of care and savings in terms of healthcare resources if in future GPs were to have the option of referring patients with OA-related problems to such a programme run regularly within their own surgery by their practice nurse. Potentially demand could be high. Over the period of one year, 25% of UK and Netherlands over 55 year olds are reported to have experienced persistent knee pain prompting one in six to have consulted their GP.³

Aim To evaluate the feasibility of implementing such a scheme in general practice and to assess the uptake of the course by both GPs and their patients.

Method 12 GPs at 6 practices were able to refer to the nurse-led OA self-management programme by a simple referral slip) any patients they considered suitable, provided that he or she had consulted them that day for a problem related to OA hip or knee. The programmes of three 2-hour sessions were held locally. A leaflet about the programme was to be given to the patient. Patients could apply by completing the short attached questionnaire and returning it in the stamped addressed envelope provided.

Results Over 9 months only 44 patients have been referred, 37 of which were interested in attending. Of the 23 so far booked into completed programmes, 11 have attended all three sessions, 5 have attended 2, and 3 have attended 1. 4 did not attend at all. The response of those who have attended has been very positive but a follow up questionnaire is planned to elicit the opinions of all those referred including nonattenders.

Discussion The rate of referral from the GPs has been far lower than anticipated. Pressure on GP time might have been a factor but the GP referral method was deliberately kept as simple as possible – hardly more detailed than a blood test request form. A number of other possibilities need to be explored: 1. Did patients consult their GP about their OA as often as anticipated? 2. Did the GPs fail to refer many suitable patients and 3. If so does this suggest that the participating GPs placed only a low value on patient self-management education for OA?

References

1. Barlow JH, Turner AP, Wright CC. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Health Educ Res. 2000;15(6):665–80

2. Rooney M, Doyle DV, Greenwood M, Tierney C. Evaluation of a community based Arthritis Self Management Programme (ASMP) for people with Osteoarthritis (OA). In: EULAR Abstracts 1999:81–2

3. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91–7