TY - JOUR
T1 - Recorded quality of primary care for osteoarthritis: an observational study
AU - Broadbent, J
AU - Maisey, SP
AU - Holland, RC
AU - Steel, N
N1 - Source:RK Note:
PY - 2008/12
Y1 - 2008/12
N2 - INTRODUCTION
Osteoarthritis causes substantial morbidity in
developed countries. In the UK it is the most
prevalent chronic disease among adults aged
65 years and over, affecting 32% of men and 47% of
women.1 It is also the most common cause of
disability.2 Osteoarthritis is an age-related condition,3
and there is a greater level of need among women
and those from more deprived backgrounds.4 Those
in poorer socioeconomic groups and women have
higher levels of need for hip and knee replacement
but receive relatively fewer joint replacements.4–6
Many individuals are living for prolonged periods with
severe osteoarthritis.
High-quality primary care is of clear importance for
such a prevalent condition that has both major
personal and social impact. This has been
recognised by the National Institute for Health and
Clinical Excellence (NICE), which has recently
published guidelines for the care and management of
osteoarthritis in adults.7 However, there is little
published information on the quality of primary care
for osteoarthritis in the UK. US studies have found
the quality of osteoarthritis primary care to be
suboptimal, with achievement of quality measures
ranging from 31% to 64%.8
This study assessed the overall quality of recorded
osteoarthritis treatment in primary care in an English
county. It also assessed whether the recorded
ABSTRACT
Background
Osteoarthritis is the most common chronic disease in
the UK, with greater prevalence in women, older
people, and those with poorer socioeconomic status.
Effective treatments are available, yet little is known
about the quality of primary care for this disabling
condition.
Aim
To measure the recorded quality of primary care for
osteoarthritis, and assess variations by patient and/or
practice characteristics.
Design of study
Retrospective observational study.
Setting
Eighteen general practices in England.
Method
Records of 320/393 randomly selected patients with
osteoarthritis (response rate 81%) were reviewed.
High-quality health care was specified by nine quality
indicators. Logistic regression modelling assessed
variations in quality by age, sex, deprivation, severity,
time since diagnosis, and practice size.
Results
There was substantial variation in the recorded
achievement of individual indicators (range 5% to
90%). The percentage of eligible patients whose
records show that they received care in the form of
information provision ranged from 17% to 30%. For
regular assessment indicators the range was 27% to
43%, and for treatment indicators the range was 5% to
90%. Recorded achievement of quality indicators was
higher in those with more severe osteoarthritis (odds
ratio [OR] 1.38, 95% CI = 1.13 to 1.69) and in older
patients (OR 1.14, 95% CI = 1.02 to 1.28). There were
no significant variations by deprivation score.
Conclusion
This study has demonstrated the feasibility of using
existing robust quality indicators to measure the quality
of primary care for osteoarthritis, and has found
considerable scope for improvement in the recording
of high-quality care. The lack of variation between
practices suggests that system-level initiatives may be
needed to achieve improvement. One challenge will be
to improve care for all, without
AB - INTRODUCTION
Osteoarthritis causes substantial morbidity in
developed countries. In the UK it is the most
prevalent chronic disease among adults aged
65 years and over, affecting 32% of men and 47% of
women.1 It is also the most common cause of
disability.2 Osteoarthritis is an age-related condition,3
and there is a greater level of need among women
and those from more deprived backgrounds.4 Those
in poorer socioeconomic groups and women have
higher levels of need for hip and knee replacement
but receive relatively fewer joint replacements.4–6
Many individuals are living for prolonged periods with
severe osteoarthritis.
High-quality primary care is of clear importance for
such a prevalent condition that has both major
personal and social impact. This has been
recognised by the National Institute for Health and
Clinical Excellence (NICE), which has recently
published guidelines for the care and management of
osteoarthritis in adults.7 However, there is little
published information on the quality of primary care
for osteoarthritis in the UK. US studies have found
the quality of osteoarthritis primary care to be
suboptimal, with achievement of quality measures
ranging from 31% to 64%.8
This study assessed the overall quality of recorded
osteoarthritis treatment in primary care in an English
county. It also assessed whether the recorded
ABSTRACT
Background
Osteoarthritis is the most common chronic disease in
the UK, with greater prevalence in women, older
people, and those with poorer socioeconomic status.
Effective treatments are available, yet little is known
about the quality of primary care for this disabling
condition.
Aim
To measure the recorded quality of primary care for
osteoarthritis, and assess variations by patient and/or
practice characteristics.
Design of study
Retrospective observational study.
Setting
Eighteen general practices in England.
Method
Records of 320/393 randomly selected patients with
osteoarthritis (response rate 81%) were reviewed.
High-quality health care was specified by nine quality
indicators. Logistic regression modelling assessed
variations in quality by age, sex, deprivation, severity,
time since diagnosis, and practice size.
Results
There was substantial variation in the recorded
achievement of individual indicators (range 5% to
90%). The percentage of eligible patients whose
records show that they received care in the form of
information provision ranged from 17% to 30%. For
regular assessment indicators the range was 27% to
43%, and for treatment indicators the range was 5% to
90%. Recorded achievement of quality indicators was
higher in those with more severe osteoarthritis (odds
ratio [OR] 1.38, 95% CI = 1.13 to 1.69) and in older
patients (OR 1.14, 95% CI = 1.02 to 1.28). There were
no significant variations by deprivation score.
Conclusion
This study has demonstrated the feasibility of using
existing robust quality indicators to measure the quality
of primary care for osteoarthritis, and has found
considerable scope for improvement in the recording
of high-quality care. The lack of variation between
practices suggests that system-level initiatives may be
needed to achieve improvement. One challenge will be
to improve care for all, without
U2 - 10.3399/bjgp08X376177
DO - 10.3399/bjgp08X376177
M3 - Article
VL - 58
SP - 839
EP - 843
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 557
ER -