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Factors associated with the setting and content of care in patients with osteoarthritis of the hip or knee
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Research Report Poster Presentation Number: RR-PO-20-10-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 FACTORS ASSOCIATED WITH THE SETTING AND CONTENT OF CARE IN PATIENTS WITH OSTEOARTHRITIS OF THE HIP OR KNEE D. Barten 1,2 , A. Smink 2 , I. Swinkels 1 , C. Veenhof 1 , H. Schers 3 , D. de Bakker 1,4 , J. Dekker 5 , C. van den Ende 2 1 Netherlands
Institute for Health Services Research (NIVEL), Utrecht, Netherlands; 2 Sint Maartenskliniek, Rheumatology, Nijmegen, Netherlands; 3 Radboud University Medical Center, Primary and Community Care, Nijmegen, Netherlands; 4 Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg, Netherlands; 5 VU University Medical Center, Rehabilitation Medicine, Amsterdam, Netherlands Background: Studies determining factors associated with the setting and content of care in patients with hip/knee osteoarthritis (OA) are mainly confined to patient demographics or disease-related factors associated with total joint replacement (TJR). To our knowledge, no studies integrated patient-related factors and factors related to the general practitioner (GP) or general practice to predict TJR, neither took attention to the content of previously utilized care. Moreover, it is unknown which factors are associated with the continuation of non-surgical care in patients once referred to secondary care. Purpose: To identify both socio-demographic, healthrelated, disease-related and content-of-care-related factors at the level of the patient, as well as socio-demographic factors at the level of the GP and the general practice associated with (1) treatment restricted to primary care, (2) TJR, and (3) continuation of non-surgical treatment after a referral to secondary care in patients with hip/knee OA. Methods: Data were used from a two-year observational prospective cohort study including 313 patients with hip/knee OA visiting their GP with a new episode of complaints. Logistic multilevel analyses were conducted to identify relevant factors. Results: The referral rate to secondary care amounted 53%. TJR was applied in 34% of this referred subpopulation, representing 18% of the total population. Non-referred patients less often reported knee OA, were faced with less severe complaints and were treated less extensively by nonsurgical interventions than referred patients. Identified factors associated with treatment restricted to primary care were less limitations in physical functioning (p = <.01) and non-use of physiotherapy (p = .03), intra-articular injections (p = <.01), and radiological assessments (p = <.01). TJR was associated with the use of radiological assessment (p < .01) and
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physiotherapy (p < .01). In the subpopulation of referred patients, having a paid job (p = .02), non-use of physiotherapy (p = <.01), and non-use of NSAIDs (p = .05) were associated with continuing non-surgical treatment. Variances were mainly located at the level of the patient (90–>99.9%), followed by the general practice (<0.1–5.3%) and the GP (<0.1–4.7%). Conclusion(s): The present study shows that the setting and content of care in patients with hip/knee OA is mainly associated with the content of previously utilized care. In particular, it could be suggested that patients who did not receive physiotherapy are more likely to stay in primary care or, once referred, to continue non-surgical treatment compared to patients who received physiotherapy. This suggests that GPs adhere to clinical guidelines and try to offer non-surgical modalities before appealing to surgical interventions. Implications: In future, more research is desired regarding the optimal moment of switch from primary to secondary care, ensuring optimal tailored treatment in patients with hip/knee OA. Keywords: Osteoarthritis; Physical therapy specialty; Primary health care Funding acknowledgements: Dutch Arthritis Association & Royal Dutch Society for Physical Therapy. Ethics approval: The original study was approved by the Medical Ethics Committee on Research Involving Human Subjects Region Arnhem-Nijmegen. http://dx.doi.org/10.1016/j.physio.2015.03.266 Research Report Platform Presentation Number: RR-PL-2200 Saturday 2 May 2015 14:51 Room 303–304 PHYSICAL THERAPY FOR KNEE AND ANKLE COMPLAINTS: DIRECT ACCESS COMPARED TO A REFERRAL FROM GENERAL PRACTICE N. Lankhorst 1 , D. Barten 2 , R. Meerhof 1 , S. Bierma-Zeinstra 1 , M. van Middelkoop 1 1 Erasmus
University Medical Center, General Practice, Rotterdam, Netherlands; 2 Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands Background: Knee and ankle complaints are frequently observed in primary care. Supervised exercise therapy, mostly performed by a physical therapist, can result in pain reduction and functional improvement in this population. In the Netherlands, since 2006 patients no longer require a referral from a physician to visit a physical therapist. To date, it is unclear which patient characteristics are associated with the mode of access to physical therapy in patients with knee and ankle complaints.
Research Report Poster Presentation Number: RR-PO-20-10-Mon Monday 4 May 2015 13:00 Exhibit halls 401–403 FACTORS ASSOCIATED WITH THE SETTING AND CONTENT OF CARE IN PATIENTS WITH OSTEOARTHRITIS OF THE HIP OR KNEE D. Barten 1,2 , A. Smink 2 , I. Swinkels 1 , C. Veenhof 1 , H. Schers 3 , D. de Bakker 1,4 , J. Dekker 5 , C. van den Ende 2 1 Netherlands
Institute for Health Services Research (NIVEL), Utrecht, Netherlands; 2 Sint Maartenskliniek, Rheumatology, Nijmegen, Netherlands; 3 Radboud University Medical Center, Primary and Community Care, Nijmegen, Netherlands; 4 Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg, Netherlands; 5 VU University Medical Center, Rehabilitation Medicine, Amsterdam, Netherlands Background: Studies determining factors associated with the setting and content of care in patients with hip/knee osteoarthritis (OA) are mainly confined to patient demographics or disease-related factors associated with total joint replacement (TJR). To our knowledge, no studies integrated patient-related factors and factors related to the general practitioner (GP) or general practice to predict TJR, neither took attention to the content of previously utilized care. Moreover, it is unknown which factors are associated with the continuation of non-surgical care in patients once referred to secondary care. Purpose: To identify both socio-demographic, healthrelated, disease-related and content-of-care-related factors at the level of the patient, as well as socio-demographic factors at the level of the GP and the general practice associated with (1) treatment restricted to primary care, (2) TJR, and (3) continuation of non-surgical treatment after a referral to secondary care in patients with hip/knee OA. Methods: Data were used from a two-year observational prospective cohort study including 313 patients with hip/knee OA visiting their GP with a new episode of complaints. Logistic multilevel analyses were conducted to identify relevant factors. Results: The referral rate to secondary care amounted 53%. TJR was applied in 34% of this referred subpopulation, representing 18% of the total population. Non-referred patients less often reported knee OA, were faced with less severe complaints and were treated less extensively by nonsurgical interventions than referred patients. Identified factors associated with treatment restricted to primary care were less limitations in physical functioning (p = <.01) and non-use of physiotherapy (p = .03), intra-articular injections (p = <.01), and radiological assessments (p = <.01). TJR was associated with the use of radiological assessment (p < .01) and
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physiotherapy (p < .01). In the subpopulation of referred patients, having a paid job (p = .02), non-use of physiotherapy (p = <.01), and non-use of NSAIDs (p = .05) were associated with continuing non-surgical treatment. Variances were mainly located at the level of the patient (90–>99.9%), followed by the general practice (<0.1–5.3%) and the GP (<0.1–4.7%). Conclusion(s): The present study shows that the setting and content of care in patients with hip/knee OA is mainly associated with the content of previously utilized care. In particular, it could be suggested that patients who did not receive physiotherapy are more likely to stay in primary care or, once referred, to continue non-surgical treatment compared to patients who received physiotherapy. This suggests that GPs adhere to clinical guidelines and try to offer non-surgical modalities before appealing to surgical interventions. Implications: In future, more research is desired regarding the optimal moment of switch from primary to secondary care, ensuring optimal tailored treatment in patients with hip/knee OA. Keywords: Osteoarthritis; Physical therapy specialty; Primary health care Funding acknowledgements: Dutch Arthritis Association & Royal Dutch Society for Physical Therapy. Ethics approval: The original study was approved by the Medical Ethics Committee on Research Involving Human Subjects Region Arnhem-Nijmegen. http://dx.doi.org/10.1016/j.physio.2015.03.266 Research Report Platform Presentation Number: RR-PL-2200 Saturday 2 May 2015 14:51 Room 303–304 PHYSICAL THERAPY FOR KNEE AND ANKLE COMPLAINTS: DIRECT ACCESS COMPARED TO A REFERRAL FROM GENERAL PRACTICE N. Lankhorst 1 , D. Barten 2 , R. Meerhof 1 , S. Bierma-Zeinstra 1 , M. van Middelkoop 1 1 Erasmus
University Medical Center, General Practice, Rotterdam, Netherlands; 2 Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands Background: Knee and ankle complaints are frequently observed in primary care. Supervised exercise therapy, mostly performed by a physical therapist, can result in pain reduction and functional improvement in this population. In the Netherlands, since 2006 patients no longer require a referral from a physician to visit a physical therapist. To date, it is unclear which patient characteristics are associated with the mode of access to physical therapy in patients with knee and ankle complaints.