First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence.
OBJECTIVE
To document adherence to two parts of the EULAR 2000 recommendations for knee osteoarthritis, concerning non-pharmacological and pharmacological first line management; and to identify factors influencing adherence to the recommendations.


METHODS
In a prospective study, 1030 randomly selected French general practitioners completed questionnaires about three unselected outpatients with osteoarthritis, and about their own practice, knowledge, and agreement with the EULAR 2000 recommendations. Percentages of adherence of their prescriptions to both parts of the recommendation were calculated, and probabilities of non-adherence analysed in relation to patient and physician related characteristics, using multilevel logistic regression analysis.


RESULTS
Data were obtained from 967 physicians and 2430 patients. The EULAR 2000 recommendations were familiar to 79% of the GPs; 99% agreed with the non-pharmacological part and 97% with the pharmacological part. Adherence to the two parts was 74.8% and 73.6%, but 54.2% for both together. Factors increasing adherence to the non-pharmacological recommendation were patient body mass index >35 kg/m(2) (odds ratio 0.11 (95% confidence interval, 0.06 to 0.21)), patient's stated preference for a treatment (OR 0.43 (0.55 to 0.97)), and physician's regular continuance of medical education (OR 0.76 (0.59 to 0.98)); patient's age and duration of symptoms decreased adherence. Factors increasing adherence to the pharmacological recommendation were gastrointestinal disease (OR 0.50 (0.35 to 0.72)) and physician's knowledge of the EULAR recommendations (OR 0.75 (0.60 to 0.93)).


CONCLUSIONS
Although most physicians agreed with the EULAR 2000 recommendations, adherence was only approximately 75% for each of the non-pharmacological and pharmacological recommendations and 54% for both together.
Denoeud
L
L
Departement of Epidemiology, Biostatistics and Clinical Research, Bichat Claude Bernard Hospital, 75018 Paris, France.
Mazières
B
B
Payen-Champenois
C
C
Ravaud
P
P
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002983:Clinical Competence; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D000700:Analgesics; D018501:Antirheumatic Agents