title: Developing a model osteoarthritis consultation: a Delphi consensus exercise.
abstract: BACKGROUND
  Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems.
  
  
  METHODS
  A postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%.
  
  
  RESULTS
  The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient's ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence.
  
  
  CONCLUSIONS
  This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.
authors: Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, United Kingdom. m.porcheret@keele.ac.uk
authors: Mark
authors: M
authors: Porcheret
authors: Janet
authors: J
authors: Grime
authors: Chris
authors: C
authors: Main
authors: Krysia
authors: K
authors: Dziedzic
mesh_terms: D018771:Arthralgia / Q000175:diagnosis; D059350:Chronic Pain / Q000175:diagnosis; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D015444:Exercise; D005260:Female; D058006:General Practice / Q000592:standards; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D059408:Pain Management; D010147:Pain Measurement; D018802:Patient-Centered Care; D010808:Physical Examination; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards; D012219:Rheumatology / Q000592:standards; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015431:Weight Loss