Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

BMC Family Practice

Research Article

Joost Dekker¹  llse CS Swinkels²  Sara A Dorsman²  Di-Janne JA Barten²  Cindy Veenhof³  Dinny H de Bakker⁴ 

[1] Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands;NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, Utrecht, BN, The Netherlands;NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, Utrecht, BN, The Netherlands;Department of Rehabilitation, Nursing Science and Sport, University Medical Center Utrecht, Utrecht, The Netherlands;NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, Utrecht, BN, The Netherlands;Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg, The Netherlands;

关键词: Osteoarthritis;    Primary health care;    General practice;    Physical therapy specialty;    Community health services;    Referral and consultation;   

DOI  :  10.1186/s12875-015-0295-9

 received in 2014-10-14, accepted in 2015-06-12,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundA multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy.MethodsData were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy.ResultsContent of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients.ConclusionIn accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.

【 授权许可】

CC BY   
© Barten et al. 2015