Di-Janne J A Barten1, Agnes Smink2, Ilse C S Swinkels1, Cindy Veenhof3, Henk J Schers4, Thea Vliet Vlieland5, Dinny H de Bakker1, Joost Dekker6, Cornelia H M van den Ende2. 1. Netherlands Institute for Health Services Research, Utrecht, The Netherlands. 2. Sint Maartenskliniek, Nijmegen, Gelderland, The Netherlands. 3. University Medical Center Utrecht, Utrecht, The Netherlands. 4. Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands. 5. University Medical Center Leiden, Leiden, The Netherlands. 6. VU University Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: We introduced a stepped-care strategy (SCS) for hip and knee osteoarthritis, focusing on delivery of high-quality stepped care. In this study, we aimed to identify factors associated with various steps of the SCS. METHODS: We used data from a 2-year observational prospective cohort study, including 313 patients visiting their general practitioner (GP) with a new episode of hip/knee osteoarthritis. We used logistic multilevel analyses to identify factors at the level of the patient, the GP, and the general practice, related to treatment limited to primary care, referral to nonsurgical secondary care, or surgical procedures. RESULTS: Patients whose treatment had been limited to primary care tended to function physically better (odds ratio [OR] 1.03). Furthermore, they less often received exercise therapy (OR 0.46), intraarticular injections (OR 0.08), and radiologic assessments (OR 0.06). Continuation of nonsurgical care after referral was more likely in employed patients (OR 2.90) and patients who had no exercise therapy (OR 0.19) or nonsteroidal antiinflammatory drugs (OR 0.35). Surgically treated patients more often received exercise therapy (OR 7.42). Referral and surgical treatment depended only to a limited extent on the GP or the general practice. CONCLUSION: After implementation of the SCS in primary care, the performance of exercise therapy, rather than disease severity or psychologic factors, seems to play a key role in the decision whether or not to refer for surgical or nonsurgical treatment in secondary care. To optimize patient-tailored treatment, future research should be adressed to determine the optimal moment of switching from primary to secondary care in patients with hip/knee osteoarthritis.
OBJECTIVE: We introduced a stepped-care strategy (SCS) for hip and knee osteoarthritis, focusing on delivery of high-quality stepped care. In this study, we aimed to identify factors associated with various steps of the SCS. METHODS: We used data from a 2-year observational prospective cohort study, including 313 patients visiting their general practitioner (GP) with a new episode of hip/knee osteoarthritis. We used logistic multilevel analyses to identify factors at the level of the patient, the GP, and the general practice, related to treatment limited to primary care, referral to nonsurgical secondary care, or surgical procedures. RESULTS:Patients whose treatment had been limited to primary care tended to function physically better (odds ratio [OR] 1.03). Furthermore, they less often received exercise therapy (OR 0.46), intraarticular injections (OR 0.08), and radiologic assessments (OR 0.06). Continuation of nonsurgical care after referral was more likely in employed patients (OR 2.90) and patients who had no exercise therapy (OR 0.19) or nonsteroidal antiinflammatory drugs (OR 0.35). Surgically treated patients more often received exercise therapy (OR 7.42). Referral and surgical treatment depended only to a limited extent on the GP or the general practice. CONCLUSION: After implementation of the SCS in primary care, the performance of exercise therapy, rather than disease severity or psychologic factors, seems to play a key role in the decision whether or not to refer for surgical or nonsurgical treatment in secondary care. To optimize patient-tailored treatment, future research should be adressed to determine the optimal moment of switching from primary to secondary care in patients with hip/knee osteoarthritis.
Authors: J M H Oomen; Y A S Peters; C H van den Ende; H J Schers; W J J Assendelft; J E Vriezekolk; S Koëter Journal: BMC Health Serv Res Date: 2022-05-12 Impact factor: 2.908
Authors: Sarah Rubia Robbins; Luciano Ricardo S Melo; Hema Urban; Leticia A Deveza; Rebecca Asher; Victoria L Johnson; David J Hunter Journal: BMJ Open Date: 2017-12-26 Impact factor: 2.692
Authors: Aniek A O M Claassen; Thea P M Vliet Vlieland; Vincent J J F Busch; Henk J Schers; Frank H J van den Hoogen; Cornelia H M van den Ende Journal: JMIR Form Res Date: 2019-11-28
Authors: Aniek A O M Claassen; Henk J Schers; Vincent J J F Busch; Petra J C Heesterbeek; Frank H J van den Hoogen; Thea P M Vliet Vlieland; Cornelia H M van den Ende Journal: BMC Med Inform Decis Mak Date: 2020-05-15 Impact factor: 2.796