Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey

BMC Health Services Research

Kåre Birger Hagen¹  Nina Østerås¹  Gudmund Grønhaug¹ 

[1] National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, 0319, Norway

关键词: Hip;    Knee;    General practitioner;    Primary care;    Quality indicator;    Osteoarthritis;   

Others  :  1090913
DOI  :  10.1186/s12913-014-0598-x

 received in 2013-05-10, accepted in 2014-11-12,  发布年份 2014

【 摘 要 】

Background

Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care.

Methods

A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables.

Results

A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1–11) and pharmacological (QIs 13–16) treatments were 50% (IQR 25–75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate.

Conclusion

Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.

【 授权许可】

   
2014 Grønhaug et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, et al.: Years lived with disability (YLDs) for sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 15:2163-2196.
• [2]Osteoarthritis: National Clinical Guideline for Care and Management in Adults. Royal College of Physicians, London; 2008.
• [3]Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B, Lequesne M, Lohmander S, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Swoboda B, Varatojo R, Verbruggen G, Zimmermann-Gorska I, Dougados M: EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2005, 64:669-681.
• [4]Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dinçer F, Dziedzic K, Häuselmann HJ, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I: EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007, 66:377-388.
• [5]Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P: OARSI recommendations for the management of hip and knee osteoarthritis, part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010, 18:476-499.
• [6]Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P: American College of Rheumatology 2012 recommendations for the use of non-pharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2012, 64:455-474.
• [7]Denoeud L, Mazieres B, Payen-Champenois C, Ravaud P: First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Ann Rheum Dis 2005, 64:70-74.
• [8]DeHaan MN, Guzman J, Bayley MT, Bell MJ: Knee osteoarthritis clinical practice guidelines – how are we doing? J Rheumatol 2007, 34:2099-2105.
• [9]Mc Hugh GA, Campbell M, Luker KA. Quality of care for individuals with osteoarthritis: A longitudinal study.J Eval Clin Pract 2011 Jan 6 doi:10.1111/j.1365-2753.2010.01616.x. [E-pub ahead of print].
• [10]Ganz DA, Chang JT, Roth CP, Guan M, Kamberg CJ, Niu F, Reuben DB, Shekelle PG, Wenger NS, MacLean CH: Quality of osteoarthritis care for community-dwelling older adults. Arthritis Rheum 2006, 55:241-247.
• [11]Broadbent J, Maisey S, Holland R, Steel N: Recorded quality of primary care for osteoarthritis: an observational study. Br J Gen Pract 2008, 58:839-843.
• [12]Gabriel SE, Crowson CS, Campion ME, O’Fallon WM: Direct medical costs unique to people with arthritis. J Rheumatol 1997, 24(4):719-725.
• [13]Gabriel SE, Crowson CS, Campion ME, O’Fallon WM: Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol 1997, 24(1):43-48.
• [14]Hochberg MC: Quality measures in osteoarthritis. Clin Exp Rheumatol 2007, 25(6 Suppl 47):102-106.
• [15]MacLean CH: Quality indicators for the management of osteoarthritis in vulnerable elders. Ann Intern Med 2001, 135:711-721.
• [16]Pencharz JN, MacLean CH: Measuring quality in arthritis care: the Arthritis Foundation’s Quality Indicator set for osteoarthritis. Arthritis Rheum 2004, 51:538-548.
• [17]Osterås N, Garrat A, Grotle M, Natvig B, Kjeken I, Kvien TK, Hagen KB. Patient-reported quality of care for osteoarthritis: Development and testing of the OsteoArthritis Quality Indicator Questionnaire.Arthritis Care Res (Hoboken), 2013. doi:10.1002/acr.21976 (Epub ahead of print).
• [18]Norwegian Directorate of Health. (Avklaring av ansvars- og oppgavefordeling mellom kommunene og spesialisthelsetjenesten på rehabiliteringsområdet). 2012 Feb. Report NO.: IS-1947.
• [19]Li LC, Sayre EC, Kopec JA, Esdaile SB, Cibere J: Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis. J Rheumatol 2011, 38:10. doi:10.3899/jrhuem.110264
• [20]Chang JT, MacLean CH, Roth CP, Wenger NS: A comparison of thequality of medical care measured by interview and medical record. J Gen Intern Med 2007, 19(suppl):S109-S110.
• [21]Askari M, Wierenga PC, Eslami S, Medlock S, de Rooij SE, Abu-Hanna A: Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review. PLoS ONE 2011, 6:e28631.
• [22]Dieppe P, Doherty M: Contextualizing osteoarthritis care and the reasons for the gap between evidence and practice. Clin Geriatr Med 2010, 26:419-431.
• [23][http:/ / www.fhi.no/ eway/ default.aspx?pid=233&trg=MainArea_5 661&MainArea_5661=5631:0:15,2691:1: 0:0:::0:0] webcite Folkehelseinnstituttet web pages: []
• [24][http://www.ssb.no/utniv/] webcite Statistics Norway: []