title: Time spent in primary care for hip osteoarthritis patients once the diagnosis is set: a prospective observational study.
abstract: BACKGROUND
  Previous research on time to referral to orthopaedic surgery has predominantly used hip complaints as starting point instead of the moment the diagnosis of osteoarthritis (OA) of the hip is established, therefore little is known about the length of time a patient diagnosed with hip OA stays under the care of a general practitioner (GP). No knowledge on factors of influence on this time period is available either. Aim of this study was thus to determine the time an incident hip OA patient stays in the care of a GP until referral to an orthopaedic department. Influencing factors were also analyzed.
  
  
  METHODS
  A prospective observational study was conducted based on data over a 10-year period from a general practice-based registration network (17 GPs, > 30,000 patients registered yearly). Patients with the diagnosis of hip OA were included. A survival analysis was used to determine time until referral to an orthopaedic department, and to determine factors of influence on this time.
  
  
  RESULTS
  Of 391 patients diagnosed with hip OA, 121 (31%) were referred; average survival time until referral was 82.0 months (95% CI 76.6-87.5). Less contact with the GP for hip complaints before the diagnosis of hip OA was established resulted in a decreased time to referral.
  
  
  CONCLUSIONS
  The results of this study show that patients with hip OA were under the care of a general practitioner, and thus in primary care, for a considerable amount of time once the diagnosis of hip OA was established.
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, The Netherlands. n.paans@orth.umcg.nl
authors.forename: Nienke
authors.initials: N
authors.lastname: Paans
authors.forename: Willem Jan
authors.initials: WJ
authors.lastname: van der Veen
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Meer
authors.forename: Sjoerd K
authors.initials: SK
authors.lastname: Bulstra
authors.forename: Inge
authors.initials: I
authors.lastname: van den Akker-Scheek
authors.forename: Martin
authors.initials: M
authors.lastname: Stevens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000628:therapy*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors