title: Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study.
abstract: BACKGROUND
  A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy.
  
  
  METHODS
  Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy.
  
  
  RESULTS
  Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients.
  
  
  CONCLUSIONS
  In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. d.barten@nivel.nl.
authors.forename: Di-Janne J A
authors.initials: DJ
authors.lastname: Barten
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. i.swinkels@nivel.nl.
authors.forename: Llse C S
authors.initials: LC
authors.lastname: Swinkels
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. saradorsman@hotmail.com.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Dorsman
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. j.dekker@vumc.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. c.veenhof-2@umcutrecht.nl.|Department of Rehabilitation, Nursing Science and Sport, University Medical Center Utrecht, Utrecht, The Netherlands. c.veenhof-2@umcutrecht.nl.
authors.forename: Cindy
authors.initials: C
authors.lastname: Veenhof
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. d.debakker@nivel.nl.|Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg, The Netherlands. d.debakker@nivel.nl.
authors.forename: Dinny H
authors.initials: DH
authors.lastname: de Bakker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010348:Patient Care Team / Q000458:organization & administration; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D012017:Referral and Consultation / Q000706:statistics & numerical data