Comparison of general practitioners and rheumatologists' prescription patterns for patients with knee osteoarthritis

Pascal Richette,Philippe Bertin,Véronique Berger,Pascal Hilliquin,Marc Marty,Paolo Carni

doi:10.1186/1471-2474-12-72

Abstract

BackgroundTo compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose NSAIDs.MethodsThis observational, prospective, national survey was carried out among a national representative sample of GPs (n = 808) and RHs (n = 134). Each physician completed a medical questionnaire for the 2 most recent patients fulfilling the ACR criteria for knee OA.ResultsGPs and RHs included 1,570 and 251 patients, respectively. Mean pain level of the knee (on a VAS, 0-100 mm) was greater for GP patients than for RH patients (49.8 ± 16.3 vs. 46.2 ± 17.1 mm, respectively; p < 0.01). As compared with patients of RHs, those of GPs more frequently had another joint affected by OA: 71.2% vs. 63.7% (p < 0.0001) and more often had hypertension and diabetes mellitus (p < 0.05).As compared with RHs, GPs more frequently prescribed low-dose NSAIDs (p < 0.0001), oral NSAIDs (p < 0.05), and topical NSAIDs (p < 0.0001) but less frequently symptomatic slow-acting drugs for OA (p < 0.01). Moreover, GPs more frequently recommended rehabilitation (p < 0.01) and loss of weight (p < 0.0001). Logistic regression analysis revealed an association of low-dose NSAIDs prescription and prescription by GPs, prescription of topical NSAIDs, no prescription of oral NSAIDs or coxibs and no intra-articular injection of steroids.ConclusionsThis study identified speciality-related variability in some aspects of the management of knee OA. The clinical profile of patients with knee OA differed between GPs and RHs.

Highlights

To compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose nonsteroidal anti-inflammatory drugs (NSAIDs)
France has about 40-fold more general practitioners (GPs; n = 101,667 in 2009) than rheumatologists (RHs; n = 2,625 in 2007) and most symptomatic knee OA is managed by GPs
The 2 groups of patients differed in relative frequencies of comorbid conditions (Table 3): hypertension and diabetes mellitus were more frequent in GP patients (p < 0.05 for both)

Summary

Introduction

To compare the prescription modalities of general practitioners (GPs) and rheumatologists (RHs) for symptomatic knee osteoarthritis (OA) and to determine correlates with prescription of low-dose NSAIDs. The prevalence of symptomatic knee OA has been recently estimated to be 9% in the general population. This estimate was computed with a Kellgren-Lawrence score of ≥1 used to define OA [2]. France has about 40-fold more general practitioners (GPs; n = 101,667 in 2009) than rheumatologists (RHs; n = 2,625 in 2007) and most symptomatic knee OA is managed by GPs. Several recommendations have been published for the treatment of knee OA, including non pharmacological and pharmacological treatments, for both GPs and RHs [3,4,5]. Use of these treatments may differ among GPs and RHs, but few studies [6] have investigated the prescription patterns of these two types of physicians for the treatment of knee OA

Methods

Results

Discussion

Conclusion