Abstract
BackgroundOsteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients.MethodsWe performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses.ResultsDiagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement.ConclusionGPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed.
Highlights
Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs
A qualitative interview study with general practitioners (GPs), practice nurses and patients with OA was performed according to the guidance for qualitative research [15]
The GPs were to have a minimum of 5 years experience; the assistants were required to have a minimum of 10 years professional experience
Summary
Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. To improve quality of care for osteoarthritis patients, evidence based guidelines and a quality indicator set exist in most countries, this, is not the case in Germany [10,11]. Practice nurses play an increasing role in providing care in many health care systems, but their perspective is often ignored [13,14]. Insight into patients', physicians' and practice nurses' views on management of OA is needed to identify problems concerning quality of care and possibilities for improvement. The aim of our study was to reveal patients' needs, assess their wish for improvement and to identify obstacles that handicap improvements. The results of this study should help create interventions for the primary care setting, evaluated in a subsequent intervention study
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