Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Preliminary effects of a regional approached multidisciplinary educational program on healthcare utilization in patients with hip or knee osteoarthritis: an observational study

Authors: Aniek A. O. M. Claassen, Henk J. Schers, Sander Koëter, Willemijn H. van der Laan, Keetie C. A. L. C. Kremers-van de Hei, Joris Botman, Vincent J. J. F. Busch, Wim H. C. Rijnen, Cornelia H. M. van den Ende

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Providing relevant information on disease and self-management helps patients to seek timely contact with care providers and become actively involved in their own care process. Therefore, health professionals from primary care, multiple hospitals and health organisations jointly decided to develop an educational program on osteoarthritis (OA). The objective of the present study was to determine preliminary effects of this OA educational program on healthcare utilization and clinical outcomes.

Methods

We developed an educational group-based program consisting of 2 meetings of 1.5 h, provided by a physiotherapist, a general practitioner (GP) and orthopaedic surgeon or specialized nurse. The program included education on OA, (expectations regarding) treatment options and self-management. Patients were recruited through searching the GPs’ electronic patients records and advertisements in local newspapers. At baseline and at 3 months follow-up participating OA patients completed questionnaires. Paired-sample t-tests, McNemar’s test and Wilcoxon Signed-Rank test were used to estimate the preliminary effects of the program.

Results

A total of 146 participants in 3 districts attended the sessions, of whom 143 agreed to participate in this study; mean age 69.1 years (SD10.2).107 (75%) participants completed both baseline and follow up assessments. The proportion of participants who had visited their GP in the 3 months after the program was lower than 3 months previous to the program (40% versus 25%, p-value 0.01). Also, we observed a decrease in proportion of patients who visited the physio- and exercise therapist, (36.1% versus 25.0%, p-value 0.02). Both illness perceptions and knowledge on OA and treatment options changed positively (Δ-1.8, 95%CI:0.4–3.4, and Δ2.4, 95%CI:-3.0 - -1.6 respectively). No changes in BMI, pain, functioning and self-efficacy were found. However, a trend towards an increase in physical activity was observed.

Conclusions

Our results show that a multidisciplinary educational program may result in a decrease in healthcare utilization and has a positive effect on illness perceptions and knowledge on OA due to clear and consistent information on OA and it treatment options.

Trial registration

Netherlands Trial Register (NTR5472). Registered 22 September 2015.
Appendix
Available only for authorised users
Literature
1.
2.
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.CrossRefPubMed
3.
Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, et al. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–15.CrossRefPubMed
4.
Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435.CrossRefPubMedPubMedCentral
5.
Otten R, van Roermund PM. Picavet HS. [trends in the number of knee and hip arthroplasties: considerably more knee and hip prostheses due to osteoarthritis in 2030]. Ned Tijdschr Geneeskd. 2010;154:A1534.PubMed
6.
Snijders GF, den Broeder AA, van Riel PL, Straten VH, de Man FH, van den Hoogen FH, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225–31.CrossRefPubMed
7.
Conrozier T, Marre JP, Payen-Champenois C, Vignon E. National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence. Clin Exp Rheumatol. 2008;26:793–8.PubMed
8.
Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. “beating osteoARThritis”: development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol. 2011;30:1623–9.CrossRefPubMed
9.
Hofstede SN, Marang-van de Mheen PJ, Vliet Vlieland TP, van den Ende CH, Nelissen RG. Van Bodegom-Vos L: barriers and facilitators associated with non-surgical treatment use for osteoarthritis patients in Orthopaedic practice. PLoS One. 2016;11:e0147406.CrossRefPubMedPubMedCentral
10.
Smink AJ, Bierma-Zeinstra SM, Dekker J, Vliet Vlieland TP, Bijlsma JW, Swierstra BA, et al. Agreement of general practitioners with the guideline-based stepped-care strategy for patients with osteoarthritis of the hip or knee: a cross-sectional study. BMC Fam Pract. 2013;14:33.CrossRefPubMedPubMedCentral
11.
Selten EM, Vriezekolk JE, Nijhof MW, Schers HJ. Van der Meulen - Dilling RG, van der Laan WH et al. barriers impeding the use of non-pharmacological, non-surgical care in hip and knee osteoarthritis: the views of general practitioners, physical therapists, and medical specialists. J of Clin Rheumatol. in press
12.
Carpenter DM, Elstad EA, Blalock SJ, DeVellis RF. Conflicting medication information: prevalence, sources, and relationship to medication adherence. J Health Commun. 2014;19:67–81.CrossRefPubMed
13.
Carpenter DM, DeVellis RF, Fisher EB, DeVellis BM, Hogan SL, Jordan JM. The effect of conflicting medication information and physician support on medication adherence for chronically ill patients. Patient Educ Couns. 2010;81:169–76.CrossRefPubMed
14.
Sanders C, Donovan JL, Dieppe PA. Unmet need for joint replacement: a qualitative investigation of barriers to treatment among individuals with severe pain and disability of the hip and knee. Rheumatology (Oxford). 2004;43:353–7.CrossRef
15.
Novak M, Costantini L, Schneider S, Beanlands H. Approaches to self-management in chronic illness. Semin Dial. 2013;26:188–94.CrossRefPubMed
16.
Selten EM, Vriezekolk JE, Geenen R, van der Laan WH, Van der Meulen-Dilling RG, Nijhof MW, et al. \Reasons for treatment choices in knee and hip osteoarthritis: a qualitative study. Arthritis Care Res (Hoboken). 2016;68:1260–7.CrossRefPubMed
17.
Smith TO, Purdy R, Lister S, Salter C, Fleetcroft R, Conaghan PG. Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography. Rheumatol Int. 2014;34:299–313.CrossRefPubMed
18.
Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–35.CrossRefPubMed
19.
Riemsma RP, Taal E, Rasker JJ, Houtman PM, Van Paassen HC, Wiegman O. Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis. Br J Rheumatol. 1996;35:755–60.CrossRefPubMed
20.
Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, et al. Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis. 2004;63:36–42.CrossRefPubMedPubMedCentral
21.
Scholz U, Doña BG, Sud S, Schwarzer RI. General self-efficacy a universal construct? Psychometric findings from 25 countries Eur J Psychol Assess. 2002;18:242–51.
22.
Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006;60:631–7.CrossRefPubMed
23.
Rademakers J, Nijman J, van der Hoek L, Heijmans M, Rijken M. Measuring patient activation in the Netherlands: translation and validation of the American short form patient activation measure (PAM13). BMC Public Health. 2012;12:577.CrossRefPubMedPubMedCentral
24.
Wagenmakers R. Van dA-S, I, Groothoff JW, Zijlstra W, Bulstra SK, Kootstra JW et al. reliability and validity of the short questionnaire to assess health-enhancing physical activity (SQUASH) in patients after total hip arthroplasty. BMC Musculoskelet Disord. 2008;9:141.CrossRefPubMedPubMedCentral
25.
26.
Stacey D, Taljaard M, Dervin G, Tugwell P, O'Connor AM, Pomey MP, et al. Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial. Osteoarthr Cartil. 2016;24:99–107.CrossRefPubMed
27.
Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet. 2004;364:1523–37.CrossRefPubMed
28.
Nolte S, Elsworth GR, Newman S, Osborne RH. Measurement issues in the evaluation of chronic disease self-management programs. Qual Life Res. 2013;22:1655–64.CrossRefPubMed
29.
Nolte S, Osborne RH. A systematic review of outcomes of chronic disease self-management interventions. Qual Life Res. 2013;22:1805–16.CrossRefPubMed
30.
Cuperus N, van den Hout WB, Hoogeboom TJ, van den Hoogen FH, Vliet Vlieland TP, van den Ende CH. Cost-utility and cost-effectiveness analyses of face-to-face versus telephone-based nonpharmacologic multidisciplinary treatments for patients with generalized osteoarthritis. Arthritis Care Res (Hoboken). 2016;68:502–10.CrossRef
31.
Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, et al. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2014;14:356.CrossRefPubMedPubMedCentral
32.
Thorstensson CA, Garellick G, Rystedt H, Dahlberg LE. Better Management of Patients with osteoarthritis: development and Nationwide implementation of an evidence-based supported osteoarthritis self-management Programme. Musculoskeletal Care. 2014;13:67–75.CrossRefPubMed
33.
Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis. 2015;74:164–9.CrossRefPubMed
34.
Pisters MF, Veenhof C, de Bakker DH, Schellevis FG, Dekker J. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial. J Physiother. 2010;56:41–7.CrossRefPubMed
35.
Egerton T, Diamond LE, Buchbinder R, Bennell KL, Slade SCA. Systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis. Osteoarthr Cartil. 2016;25:625–38.CrossRefPubMed
36.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in translation: time for a map? J Contin Educ Heal Prof. 2006;26:13–24.CrossRef
37.
38.
Keefe FJ, Caldwell DS, Baucom D, Salley A, Robinson E, Timmons K, et al. Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. Arthritis Care Res. 1999;12:101–11.CrossRefPubMed
39.
Martire LM, Stephens MA, Mogle J, Schulz R, Brach J, Keefe FJ. Daily spousal influence on physical activity in knee osteoarthritis. Ann Behav Med. 2013;45:213–23.CrossRefPubMedPubMedCentral
Metadata
Title
Preliminary effects of a regional approached multidisciplinary educational program on healthcare utilization in patients with hip or knee osteoarthritis: an observational study
Authors
Aniek A. O. M. Claassen
Henk J. Schers
Sander Koëter
Willemijn H. van der Laan
Keetie C. A. L. C. Kremers-van de Hei
Joris Botman
Vincent J. J. F. Busch
Wim H. C. Rijnen
Cornelia H. M. van den Ende
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0769-7

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue

Research article

Job satisfaction and stressors for working in out-of-hours care – a pilot study with general practitioners in a rural area of Germany

Research article

Colorectal cancer and screening awareness and sources of information in the Hungarian population

Research article

‘The big buzz’: a qualitative study of how safe care is perceived, understood and improved in general practice

Research article

Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review

Research article

Canadian family physician job satisfaction - is it changing in an evolving practice environment? An analysis of the 2013 National Physician Survey database

Research article

The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial