Evaluation of intermediate care for knee and hip osteoarthritis: a mixed-methods study

Ilgin G Arslan,Rianne M Rozendaal,Marienke Van Middelkoop,Dieuwke Schiphof,Vincent M I Voorbrood,Sita M A Bierma-Zeinstra,Patrick J E Bindels,Saskia A G Stitzinger,Maarten-Paul Van De Kerkhove

doi:10.1186/s12875-021-01474-0

Abstract

BackgroundTo evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incorporate specialist services into general practice to prevent unnecessary referrals to hospitals.MethodsWe used a mixed methods approach including semi-structured interviews, patient experience questionnaires and data from medical records from three intermediate care projects. Semi-structured interviews were conducted with patients, general practitioners (GPs), orthopaedists and a healthcare manager in intermediate care. Satisfaction of patients who received intermediate care (n = 100) was collected using questionnaires. Referral data and healthcare consumption from medical records were collected retrospectively from KHOA patients before (n = 96) and after (n = 208) the implementation of intermediate care.ResultsGPs and orthopaedists in intermediate care experienced more intensive collaboration compared to regular care. This led to a perceived increase in GPs’ knowledge enabling better selection of referrals to orthopaedics and less healthcare consumption. Orthopaedists felt a higher workload and limited access to diagnostic facilities. Patients were satisfied and experienced better access to specialists’ knowledge in a trusted environment compared to regular care. Referrals to physiotherapy increased significantly after the implementation of intermediate care (absolute difference = 15%; 95% CI = 7.19 to 22.8), but not significantly to orthopaedics (absolute difference = 5.9%; 95% CI = -6.18 to 17.9).ConclusionsOrthopaedists and GPs perceived the benefits of an intensified collaboration in intermediate care. Intermediate care may contribute to high quality of care through more physiotherapy referrals. Further research with longer follow-up is needed to confirm these findings and give more insight in referrals and healthcare consumption.

Highlights

To evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incor‐ porate specialist services into general practice to prevent unnecessary referrals to hospitals
Four patients invited by their general practitioner (GP) were interviewed
Facilitators for patients Patients and healthcare providers said that the shorter waiting times, lower out-of-pocket costs and shorter travel distances resulted in better access to healthcare, especially for elderly patients (Quote 4, Table 2)

Summary

Introduction

To evaluate intermediate care for knee and hip osteoarthritis (KHOA) in the general practice that incor‐ porate specialist services into general practice to prevent unnecessary referrals to hospitals. Hospital care accounts for the biggest component of healthcare costs, with knee and hip replacements being a substantial element [1, 3,4,5]. Previous studies have shown that inappropriate joint replacements are common before core treatments for osteoarthritis (e.g. self-management education and exercise therapy [6]) have been optimally used. This leads to high unnecessary healthcare costs [7, 8].

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Discussion

Conclusion