Health Care Use of Patients With Osteoarthritis of the Hip or Knee After Implementation of a Stepped‐Care Strategy: An Observational Study

Abstract

Objective. To enhance guideline-based nonsurgical management of osteoarthritis (OA), a multidisciplinary stepped-care strategy has been implemented in clinical practice. This study aimed to describe health care use after implementation of this strategy and to identify factors related to such use at multiple levels. Methods. For this 2-year observational prospective cohort, patients with symptomatic hip or knee OA were included by their general practitioner. Activities aligned with patients and health care providers were executed to implement the strategy. Health care use was described as the cumulative percentage of "users" for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Results. Three hundred thirteen patients were included by 70 general practitioners of 38 practices. Their mean ؎ SD age was 64 ؎ 10 years and 120 (38%) were men. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients, respectively. Fourteen percent of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis," and having limitations in functioning were recurrently identified as determinants of health care use. Conclusion. After implementation of the stepped-care strategy, most recommended nonsurgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more efforts to encourage patients with a passive coping style to use nonsurgical modalities.

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

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On the waiting list for joint replacement for knee osteoarthritis: Are first-line treatment recommendations implemented?

“…In the present study only 22% of the over-weight patients received weight-management advice prior to surgery referral, and only 15% were recommended such management once on the waiting list. This is in line with previous studies where 11–30% of over-weight patients with OA were reported to have received weight management and dietary treatment [ 44 , 45 ]. A combination of exercise and weight loss has been shown to decrease the level of inflammation, reduce compressive knee force and pain as well as improve self-efficacy and physical function compared to exercise alone in patients with OA [ 46 , 47 ].…”

Cost‐Utility and Cost‐Effectiveness Analyses of Face‐to‐Face Versus Telephone‐Based Nonpharmacologic Multidisciplinary Treatments for Patients With Generalized Osteoarthritis

“…Interestingly, in both treatment groups <20% of patients consulted a dietician, while the majority of patients (>70% in both groups) were overweight (body mass index >25 kg/m 2 ). The underutilization of dietary therapy by patients with OA is consistent with a previous study investigating the health care use of patients with hip or knee OA . This is striking as the impact of weight reduction on the predominant OA‐related symptoms, i.e., pain and function, has been well demonstrated and is considered to be one of the mainstays of rehabilitation for people with knee and hip OA .…”