title: Recorded quality of primary care for osteoarthritis: an observational study.
abstract: BACKGROUND
  Osteoarthritis is the most common chronic disease in the UK, with greater prevalence in women, older people, and those with poorer socioeconomic status. Effective treatments are available, yet little is known about the quality of primary care for this disabling condition.
  
  
  OBJECTIVE
  To measure the recorded quality of primary care for osteoarthritis, and assess variations by patient and/or practice characteristics.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Eighteen general practices in England.
  
  
  METHODS
  Records of 320/393 randomly selected patients with osteoarthritis (response rate 81%) were reviewed. High-quality health care was specified by nine quality indicators. Logistic regression modelling assessed variations in quality by age, sex, deprivation, severity, time since diagnosis, and practice size.
  
  
  RESULTS
  There was substantial variation in the recorded achievement of individual indicators (range 5% to 90%). The percentage of eligible patients whose records show that they received care in the form of information provision ranged from 17% to 30%. For regular assessment indicators the range was 27% to 43%, and for treatment indicators the range was 5% to 90%. Recorded achievement of quality indicators was higher in those with more severe osteoarthritis (odds ratio [OR] 1.38, 95% CI=1.13 to 1.69) and in older patients (OR 1.14, 95% CI=1.02 to 1.28). There were no significant variations by deprivation score.
  
  
  CONCLUSIONS
  This study has demonstrated the feasibility of using existing robust quality indicators to measure the quality of primary care for osteoarthritis, and has found considerable scope for improvement in the recording of high-quality care. The lack of variation between practices suggests that system-level initiatives may be needed to achieve improvement. One challenge will be to improve care for all, without losing the equitable distribution of care identified.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich.
authors.forename: Joanne
authors.initials: J
authors.lastname: Broadbent
authors.forename: Susan
authors.initials: S
authors.lastname: Maisey
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000628:therapy*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors