Stepped Care Strategy for patients with hip and/or knee osteoarthritis in Primary Care: a retrospective analysis of medical record data

Abstract

Background The use of non-surgical treatment in patients with hip and/or knee osteoarthritis is not optimal as studies show a poor referral to physical therapy, overuse of radiological assessments, poor prescription of medication to relieve pain, and inadequate referral to secondary care. To improve use of non-surgical treatment, the Primary Care Stepped Care Strategy Osteoarthritis was developed and implemented in the Julius Healthcare Centres.

Aim To compare health care use and sequence of care in patients with hip and/or knee osteoarthritis before and after pilot implementation of the Primary Care Stepped Care Strategy Osteoarthritis.

Methods A pilot evaluation was conducted after implementation of the Primary Care Stepped Care Strategy Osteoarthritis within four primary healthcare centres, using a retrospective analysis of medical records. Data on health care use and sequence of care were extracted from medical records of general practitioners and physical therapists. Newly diagnosed patients with hip and/or knee osteoarthritis were included before and after pilot implementation.

Results The current study included 28 patients: 11 before and 17 after pilot implementation. After pilot implementation, a higher proportion of patients received physical therapy and medication to relieve pain. A lower proportion of patients received radiological assessments and secondary care. A higher proportion of patients received correct sequence of care before referral to physical therapy and medication according to the correct sequence after pilot implementation.

Conclusion The results suggest that implementation of the Primary Care Stepped Care Strategy Osteoarthritis might positively influence health care use and sequence of care in patients with hip and/or knee osteoarthritis.

Clinical Relevance Implementation of the Primary Care Stepped Care Strategy Osteoarthritis might improve use of non-surgical care and decrease referral to secondary care in patients with hip and/or knee osteoarthritis. However, further research in a larger sample is needed to confirm the results.