Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice

Abstract

BackgroundA stepped care strategy (SCS) to improve adequate healthcare use in patients with osteoarthritis was developed and implemented in a primary care region in the Netherlands. AimTo assess the association between care that is in line with the SCS recommendations and health outcomes. Design and settingData were used from a 2-year observational study of 313 patients who had consulted their GP because of osteoarthritis. MethodCare was considered 'SCS-consistent' if all advised modalities of the previous steps of the SCS were offered before more advanced modalities of subsequent steps. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (range 0-100); active pain coping with the Pain Coping Inventory (range 10-40); and self-efficacy with the Dutch General Self-Efficacy Scale (range 12-48). Crude and adjusted associations between SCS-consistent care and outcomes were estimated with generalised estimating equations. ResultsNo statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). This was also the case after adjusting for possible confounders, that is, -4.3 (95% confidence interval [CI] = -10.3 to 1.7) and -1.9 (95% CI = -7.0 to 3.1), respectively. Furthermore, no differences were found in changes over time between groups in self-efficacy and pain coping. ConclusionThe results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects.Keywords general practice; osteoarthritis; outcome of care; stepped care strategy.

The Development of a Surgical Readiness Interview Tool for Patients to Improve Conversation on Modifiable Risk Factors Prior to Total Joint Arthroplasty

“…With the stepped care approach, it is imperative to both the patient and the health care system to complete the adequate steps in an ordered manner, and the steps should need to be done prior to invasive therapy. Further, to provide Readiness Interview Tool for Joint Arthroplasty 18 value, a stepped care strategy needs to be consistent within primary care, as there are effects on costs and long-term effects (22). In a previous study that evaluated the extent to which clinical practice was consistent with the stepped care strategy in hip or knee OA, consistency was found in about half of the patients within the aspects of care (consistency regarding timing of radiological assessment, sequence of non-surgical treatment options, and making follow-up appointments) (23).…”

Effectiveness of Stepped‐Care Intervention in Overweight and Obese Patients With Medial Tibiofemoral Osteoarthritis: A Randomized Controlled Trial

“…A further and more target step is only considered when clinical goals are not met, thus minimizing the use of complex and costly interventions needlessly (17). To our knowledge, only observational studies have investigated the stepped‐care approach in OA (18–22).…”

Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial

“…In addition, a handful of other OA management programmes, employing less rigorous, observational study designs have previously been set up in a limited number of countries [9,10]. Generally, these programmes report somewhat diverging, but overall promising effects on pain and physical function [11][12][13]. In summary, more high-quality studies to evaluate effects of OA management programmes in primary care are currently warranted.…”