Case management of arthritis patients in primary care: a cluster-randomized controlled trial.
OBJECTIVE
To assess whether providing information on arthritis self-management through general practitioners (GPs) increases the quality of life in patients with osteoarthritis and whether additional case management provided by practice nurses shows better results.


METHODS
We conducted a pragmatic, cluster-randomized, controlled, 3-arm trial that included 1,021 patients from 75 primary care practices in Germany. GPs were randomized to intervention group I, group II, or a control group. GPs of both intervention groups participated in 2 peer group meetings. In intervention group II, additional case management was conducted via telephone by a practice nurse. The primary outcome was change in quality of life, assessed by the German version of the Arthritis Impact Measurement Scales Short Form (AIMS2-SF). Secondary outcomes were health service utilization, prescriptions, and physical activity. Data were controlled for depression using the Patient Health Questionnaire 9 as a potential confounder.


RESULTS
Of 1,125 administered questionnaires, 1,021 were analyzed. Compared with the control group, no significant changes occurred in intervention group I with respect to the primary outcome. Performed radiographs decreased significantly (P = 0.050), whereas prescriptions of acetaminophen increased significantly (P < 0.001). In intervention group II, significant changes in the AIMS2-SF dimensions social (P < 0.001), symptom (P = 0.048), and lower body (P = 0.049) were identified. Radiographs (P = 0.031) and orthopedic referrals (P = 0.044) decreased whereas prescriptions of pain relievers increased significantly.


CONCLUSIONS
Improving the quality of life in patients with arthritis using arthritis self-management seems challenging. Simply providing this information through GPs is not sufficient but combining it with case management seems to be a promising approach.
University Hospital of Heidelberg, Heidelberg, Germany. thomas_rosemann@med.uni-heidelberg.de
Thomas
T
Rosemann
Stefanie
S
Joos
Gunter
G
Laux
Jochen
J
Gensichen
Joachim
J
Szecsenyi
D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019090:Case Management; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010353:Patient Education as Topic; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D011859:Radiography; D012648:Self Care / Q000379:methods*