Non-surgical care in patients with hip or knee osteoarthritis is modestly consistent with a stepped care strategy after its implementation.
OBJECTIVE
To improve the management of hip or knee osteoarthritis (OA), a stepped care strategy (SCS) has been developed that presents the optimal sequence for care in three steps. This study evaluates the extent to which clinical practice is consistent with the strategy after implementation and identifies determinants of SCS-consistent care.


METHODS
A 2-year observational prospective cohort study.


METHODS
General practices in the region of Nijmegen in the Netherlands.


METHODS
Three hundred and thirteen patients with hip or knee OA and their general practitioner (GP).


METHODS
Multifaceted interventions were developed to implement the strategy.


METHODS
Consistency between clinical practice and the strategy was examined regarding three aspects of care: (i) timing of radiological assessment, (ii) sequence of non-surgical treatment options and (iii) making follow-up appointments.


RESULTS
Out of the 212 patients who reported to have had an X-ray, 92 (44%) received it in line with the SCS. The sequence of treatment was inconsistent with the SCS in 58% of the patients, which was mainly caused by the underuse of lifestyle advice and dietary therapy. In 57% of the consultations, the patient reported to have been advised to make a follow-up appointment. No determinants that influenced all three aspects of care were identified.


CONCLUSIONS
Consistency with the SCS was found in about half of the patients for each of the three aspects of care. Health care can be further optimized by encouraging GP s to use X-rays more appropriately and to make more use of lifestyle advice, dietary therapy and follow-up appointments.
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Agnes J
AJ
Smink
Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Sita M A
SM
Bierma-Zeinstra
Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Henk J
HJ
Schers
Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands.
Bart A
BA
Swierstra
Dutch Patient Organization for Rheumatic Diseases, Amersfoort, The Netherlands.
Joke H
JH
Kortland
Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
Johannes W J
JW
Bijlsma
Department for Health Evidence, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Steven
S
Teerenstra
Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Theo B
TB
Voorn
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Joost
J
Dekker
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Thea P M
TP
Vliet Vlieland
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Cornelia H M
CH
van den Ende
D000368:Aged; D000700:Analgesics; D004032:Diet; D019468:Disease Management; D005260:Female; D058005:General Practitioners; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000628:therapy*; D010353:Patient Education as Topic; D011446:Prospective Studies; D011787:Quality of Health Care; D011859:Radiography
D000700:Analgesics
general practice; implementation; osteoarthritis, hip; osteoarthritis, knee; quality of care; sequence for care