Australian GP management of osteoarthritis following the release of the RACGP guideline for the non-surgical management of hip and knee osteoarthritis

Martin Basedow, Helena Williams, E Michael Shanahan, William B Runciman, Adrian Esterman, Martin Basedow, Helena Williams, E Michael Shanahan, William B Runciman, Adrian Esterman

Abstract

Background: Osteoarthritis (OA) is a highly disabling and costly condition with an escalating prevalence in Australia due to the ageing and increasing obesity of the population. The general practitioner (GP) plays a central role in the management of this condition. The aim of this study was to examine opinions about the management of OA by Australian GPs following the release of the Royal Australian College of General Practitioners Guideline for the non-surgical management of hip and knee OA (RACGP OA CPG), and to compare the results with an earlier survey administered by the National Prescribing Service.

Methods: In January 2013, a self-administered questionnaire was sent to 228 GPs to determine their treatment approaches to OA management using a clinical vignette of a patient with OA. This was compared with results from a similar survey undertaken in 2006.

Results: Seventy-nine GPs returned questionnaires (response rate 35%). GP recommendations for paracetamol, a paracetamol/codeine compound, and oral non-steroidal anti-inflammatory drugs (NSAIDs) were consistent with recommendations in the RACGP OA CPG, and varied little from the previous survey. Notably, there was a marked increase between surveys in GP recommendations for tramadol (p = 0.004) and more potent opioids (p < 0.001). Advice about the adverse effects of NSAIDs and codeine and how to manage them increased between surveys (p = 0.038 and 0.005, respectively). For all non-pharmacological treatments, there were only minor changes in the percentage of GP recommendations when compared with the previous survey, however they remain underutilised.

Conclusions: GPs generally demonstrated a conservative approach to the treatment of OA, however, the increased recommendations for more potent opioids warrants further investigation. Patients should be made aware of the risks of medications through the use of decision aids, which can provide structured guidance to treatment. Non-pharmacological interventions were not given the importance that is suggested by clinical practice guidelines.

Figures

Fig. 1
Fig. 1
Clinical vignette

References

    1. Arthritis and Osteoporosis Victoria . A problem worth solving. Melbourne: Arthritis and Osteoarthritis Victoria; 2013.
    1. March LM, Bagga H. Epidemiology of osteoarthritis in Australia. Med J Aust. 2004;180:1.
    1. Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, et al. General practice activity in Australia 2010–11. Sydney: Sydney University Press; 2011.
    1. Brand CA, Harrison C, Tropea J, Hinman RS, Britt H, Bennell K. Management of osteoarthritis in general practice in Australia. Arthritis Care Res. 2014;66:551–558. doi: 10.1002/acr.22197.
    1. Basedow M, Esterman A. Assessing appropriateness of osteoarthritis care using quality indicators: a systematic review. J Eval Clin Pract. 2015
    1. Brand C. Translating evidence into practice for people with osteoarthritis of the hip and knee. Clin Rheumatol. 2007;26:1411–1420. doi: 10.1007/s10067-007-0633-y.
    1. Carlsen B, Glenton C, Pope C. Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. Br J Gen Pract. 2007;57(545):971–978. doi: 10.3399/096016407782604820.
    1. The Royal Australian College of General Practitioners Working Group: Guideline for the non-surgical management of hip and knee osteoarthritis. Melbourne: The Royal Australian College of General Practitioners; 2009.
    1. National Prescribing Service Limited . Results: Case study 44: selecting analgesics. Sydney: NPS; 2006.
    1. Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust. 2012;197(2):100–105. doi: 10.5694/mja12.10510.
    1. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–388. doi: 10.1016/j.joca.2014.01.003.
    1. Barozzi N, Tett SE. Perceived barriers to paracetamol (acetaminophen) prescribing, especially following rofecoxib withdrawal from the market. Clin Rheumatol. 2009;28:509–519. doi: 10.1007/s10067-008-1077-8.
    1. National Prescribing Service Limited . National prescribing service newsletter—analgesic options for pain relief. Sydney: Quality Use of Medicines; 2006.
    1. Bennell K, Hunter D, Hinman R. Management of osteoarthritis of the knee. Br Med J. 2012
    1. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64:465–474. doi: 10.1002/acr.21596.
    1. Carroll GJ: How to treat osteoarthritis. Australian Doctor. 2009.
    1. National Prescribing Service Limited . Results: Case Study 44: selecting analgesics. Sydney: NPS; 2006.
    1. Howes F, Buchbinder R, Winzenberg TB. Opioids for osteoarthritis? Weighing benefits and risks: a Cochrane Musculoskeletal Group review. J Fam Pract. 2011;60:206–212.
    1. Harrison CM, Charles J, Henderson J, Britt H. Opioid prescribing in Australian general practice. Med J Aust. 2012;196:380–381. doi: 10.5694/mja12.10168.
    1. Australian Institute of Health and Welfare . Medication use for arthritis and osteoporosis. Canberra: AIHW; 2010.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18:476–499. doi: 10.1016/j.joca.2010.01.013.
    1. Marik PE, Varon J. Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol. 2009;32:365–372. doi: 10.1002/clc.20604.
    1. Bellamy N, Campbell J, Welch V, Gee T, Bourne R, Wells G: Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev; 2006. . Accessed 1 Aug 2015.
    1. Brand CA. The role of self-management in designing care for people with osteoarthritis of the hip and knee. Med J Aust. 2008;189:S25–S28.
    1. Harris MF, Jayasinghe UW, Taggart JR, Christl B, Proudfoot JG, Crookes PA, et al. Multidisciplinary team care arrangements in the management of patients with chronic disease in Australian general practice. Med J Aust. 2011;194:236–239.
    1. Brosseau L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database Syst Rev; 2003. . Accessed 1 Aug 2015.
    1. Arthritis Research UK. Practitioner-based complementary and alternative therapies for the treatment of rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain. Chesterfield: Arthritis Research UK; 2013.
    1. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010; . Accessed 1 Aug 2015.
    1. Alami S, Boutron I, Desjeux D, Hirschhorn M, Meric G, Rannou F, et al. Patients’ and practitioners’ views of knee osteoarthritis and its management: a qualitative interview study. PLoS One. 2011;6:e19634. doi: 10.1371/journal.pone.0019634.
    1. Sale JEM, Gignac M, Hawker G. How “bad” does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis. Arthritis Care Res. 2006;55(2):272–278. doi: 10.1002/art.21853.
    1. Milder TY, Williams KM, Ritchie JE, Lipworth WL, Day RO. Use of NSAIDs for osteoarthritis amongst older-aged primary care patients: engagement with information and perceptions of risk. Age Ageing. 2011;40:254–259. doi: 10.1093/ageing/afq160.
    1. Cochrane Musculoskeletal Group. Decision Aids. . Accessed 1 Aug 2015.
    1. Runciman WB, Coiera EW, Day RO, Hannaford NA, Hibbert PD, Hunt TD, et al. Towards the delivery of appropriate health care in Australia. Med J Aust. 2012;197:78–81. doi: 10.5694/mja12.10799.
    1. Australian Bureau of Statistics. GP Workforce Statistics—1984-85 to 2013-14. . Accessed 1 Aug 2015.
    1. Primary Health Care Research and Information Service. PHCRIS Fast Fact, General Practice Size in Australia 2005-06 to 2010-11, June 2014. . Accessed 1 Aug 2015.
    1. Cook JV, Dickinson HO, Eccles MP. Response rate in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res. 2009;9:160. doi: 10.1186/1472-6963-9-160.

Source: PubMed

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