Management of Osteoarthritis in General Practice in Australia

Abstract

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.

What Do People With Knee or Hip Osteoarthritis Need to Know? An International Consensus List of Essential Statements for Osteoarthritis

“…However, there is a potential risk of "information overload" if clinicians presented all of the key messages recommended by clinical guidelines to patients. The suboptimal use of evidence-based nondrug therapies in primary care settings for the management of osteoarthritis highlights the need for patients to have access to a list of patient-friendly, plain-language, patient messages (8). Furthermore, time available for face-to-face education by health professionals is usually limited in most health care consultations (5).…”

“…Clinical guidelines emphasize that management of osteoarthritis should focus on conservative nondrug treatments, particularly exercise, and weight loss for patients who are overweight or obese (7). People living with osteoarthritis typically self-manage their condition in the community in collaboration with their family doctor (8). Plain language, evidence-based, and succinct and practical key messages for people with osteoarthritis are an essential component of community care.…”

Is There a Dose‐Response Relationship Between Weight Loss and Symptom Improvement in Persons With Knee Osteoarthritis?

“…This phenomenon is attributed to patient difficulties in seeking health care, as well as to patients experiencing difficulties in adherence and engagement with recommended strategies. In addition, clinicians do not effectively promote weight loss in their patients (11). Despite several published trials of weight loss in persons with KOA, insufficient heed has been paid to community implementation and real-world effectiveness (12).…”

The effect on knee-joint load of instruction in analgesic use compared with neuromuscular exercise in patients with knee osteoarthritis: study protocol for a randomized, single-blind, controlled trial (the EXERPHARMA trial)

“…These include information, exercise, and weight loss, and are preferred for their anticipated negligible adverse effects while still having relevant clinical efficacy. Despite this, both over-the-counter and prescribed pain-reducing pharmacologic agents (analgesics and antiinflammatory agents) are widely and more commonly used treatments for knee OA in primary health care [7]. Although these are preferred for their ease of application and dose-dependent pain-relieving effect [8], they also have dose-dependent adverse effects [9–11].…”