Skip to main content
Top

17-08-2018 | Osteoarthritis | Article

Uptake of the NICE osteoarthritis guidelines in primary care: a survey of older adults with joint pain

Journal: BMC Musculoskeletal Disorders

Authors: Emma Louise Healey, Ebenezer K. Afolabi, Martyn Lewis, John J. Edwards, Kelvin P. Jordan, Andrew Finney, Clare Jinks, Elaine M. Hay, Krysia S. Dziedzic

Publisher: BioMed Central

Abstract

Background

Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake.

Methods

A cross-sectional survey mailed to adults aged ≥45 years (n = 28,443) from eight general practices in the UK as part of the MOSAICS study. Respondents who reported the presence of joint pain, a consultation in the previous 12 months for joint pain, and gave consent to medical record review formed the sample for this study.

Results

Four thousand fifty-nine respondents were included in the analysis (mean age 65.6 years (SD 11.2), 2300 (56.7%) females). 502 (12.4%) received an OA diagnosis in the previous 12 months. More participants reported using pharmacological treatments (e.g. paracetamol (31.3%), opioids (40.4%)) than non-pharmacological treatments (e.g. exercise (3.8%)). Those with an OA diagnosis were more likely to use written information (OR 1.57; 95% CI 1.26,1.96), paracetamol (OR 1.30; 95% CI 1.05,1.62) and topical NSAIDs (OR 1.30; 95% CI 1.04,1.62) than those with a joint pain code. People aged ≥75 years were less likely to use written information (OR 0.56; 95% CI 0.40,0.79) and exercise (OR 0.37; 95% CI 0.25,0.55) and more likely to use paracetamol (OR 1.91; 95% CI 1.38,2.65) than those aged < 75 years.

Conclusion

The cross-sectional population survey was conducted to examine the uptake of the treatments that are recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and to determine whether patient characteristics or OA diagnosis impact uptake. Non-pharmacological treatment was suboptimal compared to pharmacological treatment. Implementation of NICE guidelines needs to examine why non-pharmacological treatments, such as exercise, remain under-used especially among older people.
Literature
1.
Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2163–96.CrossRefPubMed
2.
National Institute for Health & Clinical Excellence. NICE clinical guideline [CG59] osteoarthritis: the care and management of osteoarthritis in adults. London: National Institute for Health & Clinical Excellence; 2008.
3.
Thomas E, Peat G, Croft P. Defining and mapping the person with osteoarthritis for population studies and public health. Rheumatology (Oxford, England). 2014;53(2):338–45.CrossRef
4.
Jordan KP, Joud A, Bergknut C, et al. International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden. Ann Rheum Dis. 2014;73(1):212–8.CrossRefPubMed
5.
Hagen KB, Smedslund G, Osteras N, et al. Quality of community-based osteoarthritis care: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2016;68(10):1443–52.CrossRef
6.
Mamlin LA, Melfi CA, Parchman ML, et al. Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med. 1998;7(6):563–7.CrossRefPubMed
7.
Rosemann T, Wensing M, Joest K, et al. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses. BMC Musculoskelet Disord. 2006;7:48.CrossRefPubMedPubMedCentral
8.
Dziedzic KS, Healey EL, Porcheret M, et al. Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the management of OsteoArthritis in consultations (MOSAICS) study protocol. Implement Sci. 2014;9(1):95.CrossRefPubMedPubMedCentral
9.
Dziedzic KS, Healey EL, Porcheret M, et al. Implementing Core NICE guidelines for osteoarthritis in primary care with a model consultation: MOSAICS a cluster randomised controlled trial. Osteoarthr Cartil. 2018;26(1):43–53. https://​doi.​org/​10.​1016/​j.​joca.​2017.​09.​010.CrossRefPubMedPubMedCentral
10.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.CrossRefPubMed
11.
Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefPubMed
12.
Jinks C, Jordan K, Ong BN, et al. A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over. Rheumatology (Oxford, England). 2004;43(1):55–61.CrossRef
13.
Brilleman SL, Salisbury C. Comparing measures of multimorbidity to predict outcomes in primary care: a cross sectional study. Fam Pract. 2013;30(2):172–8.CrossRefPubMed
14.
Hovstadius B, Hovstadius K, Astrand B, et al. Increasing polypharmacy - an individual-based study of the Swedish population 2005-2008. BMC Clin Pharmacol. 2010;10:16.CrossRefPubMedPubMedCentral
15.
Porcheret M, Jordan K, Jinks C, et al. Primary care treatment of knee pain--a survey in older adults. Rheumatology (Oxford, England). 2007;46(11):1694–700.CrossRef
16.
Cottrell E, Roddy E, Foster NE. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review. BMC Fam Pract. 2010;11:4.CrossRefPubMedPubMedCentral
17.
National Institute for Health & Clinical Excellence. NICE clinical guideline [CG177] osteoarthritis: the care and management of osteoarthritis in adults. London: National Institute for Health & Clinical Excellence; 2014.
18.
Jordan KP, Tan V, Edwards JJ, et al. Influences on the decision to use an osteoarthritis diagnosis in primary care: a cohort study with linked survey and electronic health record data. Osteoarthritis Cartilage. 2016;24(5):786–93.CrossRefPubMedPubMedCentral
19.
Keenan AM, Tennant A, Fear J, et al. Impact of multiple joint problems on daily living tasks in people in the community over age fifty-five. Arthritis Rheum. 2006;55(5):757–64.CrossRefPubMed
20.
Craig R, Mindell J, Hirani V. Health survey for England 2008: physical activity and fitness. 2009.
21.
Strauss VY, Carter P, Ong BN, et al. Public priorities for joint pain research: results from a general population survey. Rheumatology. 2012;51:20752082. https://​doi.​org/​10.​1093/​rheumatology/​kes179.CrossRef
22.
Edwards JJ, Jordan KP, Peat G, et al. Quality of care for OA: the effect of a point-of-care consultation recording template. Rheumatology (Oxford, England). 2015;54(5):844–53.CrossRef
23.
Paskins Z, Sanders T, Hassell AB. Comparison of patient experiences of the osteoarthritis consultation with GP attitudes and beliefs to OA: a narrative review. BMC Fam Pract. 2014;15:46.CrossRefPubMedPubMedCentral
24.
Uthman OA, van der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:f5555.CrossRefPubMedPubMedCentral
25.
Christensen R, Bartels EM, Astrup A, et al. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66(4):433–9.CrossRefPubMedPubMedCentral
26.
Jordan JL, Holden MA, Mason EE, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010;1:CD005956.
27.
Larmer PJ, Reay ND, Aubert ER, et al. Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil. 2014;95(2):375–89.CrossRefPubMed