title: Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study.
abstract: BACKGROUND
  To improve the management of hip or knee osteoarthritis (OA), a multidisciplinary guideline-based stepped-care strategy (SCS) with recommendations regarding the appropriate non-surgical treatment modalities and optimal sequence for care has been developed. Implementation of this SCS in the general practice may be hampered by the negative attitude of general practitioners (GPs) towards the strategy. In order to develop a tailored implementation plan, we assessed the GPs' views regarding specific recommendations in the SCS and their working procedures with regard to OA.
  
  
  METHODS
  A survey was conducted among a random sample of Dutch GPs. Questions included the GP's demographical characteristics and the practice setting as well as how the management of OA was organized and whether the GPs supported the SCS recommendations. In particular, we assessed GP's views regarding the effectiveness of 14 recommended and non-recommended treatment modalities. Furthermore, we calculated their agreement with 7 statements based on the SCS recommendations regarding the sequence for care. With a linear regression model, we identified factors that seemed to influence the GPs' agreement with the SCS recommendations.
  
  
  RESULTS
  Four hundred fifty-six GPs (37%) aged 30-65 years, of whom 278 males (61%), responded. Seven of the 11 recommended modalities (i.e. oral Non-Steroidal Anti-Inflammatory Drugs, physical therapy, glucocorticoid intra-articular injections, education, lifestyle advice, acetaminophen, and tramadol) were considered effective by the majority of the GPs (varying between 95-60%). The mean agreement score, based on a 5-point scale, with the recommendations regarding the sequence for care was 2.8 (SD = 0.5). Ten percent of the variance in GPs' agreement could be explained by the GPs' attitudes regarding the effectiveness of the recommended and non-recommended non-surgical treatment modalities and the type of practice.
  
  
  CONCLUSIONS
  In general, GPs support the recommendations in the SCS. Therefore, we expect that their attitudes will not impede a successful implementation in general practice. Our results provide several starting points on which to focus implementation activities for specific SCS recommendations; those related to the prescription of pain medication and the use of X-rays. We could not identify factors that contribute substantially to GPs' attitudes regarding the SCS recommendations regarding the sequence for care.
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, PO box 9011, 6500 GM Nijmegen, The Netherlands. a.smink@maartenskliniek.nl
authors.forename: Agnes J
authors.initials: AJ
authors.lastname: Smink
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Bart A
authors.initials: BA
authors.lastname: Swierstra
authors.forename: Joke H
authors.initials: JH
authors.lastname: Kortland
authors.forename: Theo B
authors.initials: TB
authors.lastname: Voorn
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D005260:Female; D058006:General Practice / Q000458:organization & administration; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000628:therapy*; D059408:Pain Management; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011859:Radiography
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids