Abstract
BackgroundOsteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems.MethodsA postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%.ResultsThe model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient’s ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence.ConclusionsThis study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.
Highlights
Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance
What are the potential components of an ideal consultation for OA? To investigate this we have undertaken a consensus exercise to determine the views of patients and clinicians about the possible content of an “ideal” consultation between a general practitioner (GP) and a patient presenting with joint pain
There are evidence-based frameworks for medical consultations, notably the Calgary-Cambridge Framework [13], and there is the background science about primary care OA management summarised in the NICE guidelines, there is no empirical evidence to guide the identification of the specific content of a model OA consultation
Summary
Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. There are evidence-based frameworks for medical consultations, notably the Calgary-Cambridge Framework [13], and there is the background science about primary care OA management summarised in the NICE guidelines, there is no empirical evidence to guide the identification of the specific content of a model OA consultation. In such circumstances, consensus studies with experts have been advocated as the “ best” option [14,15]. The relevant “experts” are the two participants in the consultation, namely, in the UK, the general practitioner (GP) and the patient presenting with OA [16]
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