Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses.
BACKGROUND
Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients.


METHODS
We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses.


RESULTS
Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement.


CONCLUSIONS
GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed.
Rosemann
Thomas
T
Department of General Practice and Health Services Research, University of Heidelberg, Vossstr, 2, 69115 Heidelberg, Germany. thomas_rosemann@med.uni-heidelberg.de
Wensing
Michel
M
Joest
Katharina
K
Backenstrass
Matthias
M
Mahler
Cornelia
C
Szecsenyi
Joachim
J
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010003:Osteoarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D010361:Patients / Q000523:psychology*; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care