Educational outreach visits to improve knee osteoarthritis management in primary care

David Spitaels,Bert Aertgeerts,Patrik Vankrunkelsven,Dieter Van Assche,Rosella P M G Hermens,Frank P Luyten,Sabine Verschueren,Hilde Vandenneucker

doi:10.1186/s12909-019-1504-3

Abstract

BackgroundKnee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy.MethodsAn educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP.ResultsThe intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group.ConclusionsThis intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners’ prescription behavior, more extensive or combined interventional approaches seem warranted.

Highlights

Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines
In Belgium, the referral rate of patients with knee osteoarthritis for physical therapy is low: an electronic health record review of 576 patients with knee osteoarthritis in primary care showed that only 11% of the patients were referred for physical therapy as part of the non-surgical treatment options, indicating poor guideline adherence [15]
Baseline demographic characteristics in the two groups were comparable, with the exception of gender (p < 0.019) and practice type (p < 0.002): female practitioners were more dominant in the control group (56.3% vs 38.4%) and more General practitioner (GP) worked in group practices in the control group (60.2% vs 37.0%) (Table 1)

Summary

Introduction

Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Quality indicators are important tools in assessing and monitoring the quality of care For this purpose, a Belgian set of 21 process quality indicators for knee osteoarthritis management, based on international evidence-based guidelines, was developed by a multidisciplinary expert panel [14]. A Belgian set of 21 process quality indicators for knee osteoarthritis management, based on international evidence-based guidelines, was developed by a multidisciplinary expert panel [14] This Belgian set of indicators involves recommendations for diagnosis, lifestyle advice, treatment and follow-up in primary care. According to these quality indicators, patients with symptomatic knee osteoarthritis should be referred to a physical therapist for appropriate exercise therapy. In Belgium, the referral rate of patients with knee osteoarthritis for physical therapy is low: an electronic health record review of 576 patients with knee osteoarthritis in primary care showed that only 11% of the patients were referred for physical therapy as part of the non-surgical treatment options, indicating poor guideline adherence [15]

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