Results. There were 489,900 GP encounters at which OA was managed (rate of 26.4 per 1,000 encounters). OA-hip was managed at a rate of 2.3 per 1,000 encounters (n ؍ 1,106, 8.6% OA) and OA-knee at a rate of 6.2 per 1,000 (n ؍ 3,058, 23.7% OA). The encounter management rate per 1,000 for OA-hip was higher among non-metropolitan dwellers (2.85 per 1,000 versus 1.97 per 1,000) and lower for non-English-speaking people (1.53 per 1,000 encounters versus 2.39 per 1,000). The rate for OA-knee was higher for non-English-speaking background (8.50 per 1,000 encounters versus 6.24 per 1,000) and lower among indigenous people (3.16 per 1,000 encounters versus 6.46 per 1,000). Referral to an orthopedic surgeon was the most frequently used nonpharmacologic management (OA-knee 17.4 per 100 contacts and OA-hip 17.7 per 100), followed by advice, education, and counselling. As first-line treatment, medication prescription rates (OA-knee 78.7 per 100 contacts and OA-hip 73.2 per 100) were substantially higher than rates of lifestyle management (OA-knee 20.7 per 100 contacts and OA-hip 14.8 per 100). Conclusion. OA-hip and OA-knee encounters and management differ. Nonpharmacologic treatments as first-line management were low compared with pharmacologic management rates, and surgical referral rates were high. However, lack of longitudinal data limits definitive assessment of appropriateness of care.
Delirium is a common and serious condition which is often overlooked or misdiagnosed in older people. In 2006, the first set of national clinical practice guidelines for the management of delirium in older people were developed. This paper provides an abbreviated version of the guideline document which includes recommendations for the detection of delirium (diagnosis and screening), assessment and prediction of risk factors for delirium, prevention of delirium and interventions to manage people with delirium. The guidelines reflect the available evidence base and highlight the limited high level research in delirium care, particularly in the areas of symptom management and screening for delirium.
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