Recorded quality of primary care for osteoarthritis: an observational study

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