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首页> 外文期刊>BMC Family Practice >Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study
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Treatment of hip/knee osteoarthritis in Dutch general practice and physical therapy practice: an observational study

机译：荷兰普通实践和物理治疗实践对髋/膝骨关节炎的治疗：一项观察性研究

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Background A multidisciplinary, guideline-based Stepped-Care-Strategy (SCS), has recently been developed to improve the management of hip and knee osteoarthritis (OA). To date, it is unknown to what extent current Dutch OA care is consistent with the SCS, both with respect to the content of care as well as the sequence of care. Furthermore, there is a lack of clarity regarding the role of different health care providers in the performance of OA care according to the SCS. Therefore, the main purpose of this study is to describe the content of primary care in patients with hip/knee OA, including the compliance to the SCS and taking into account the introduction of patient self-referral to physical therapy. Methods Data were used from NIVEL Primary Care Database. In total, 12.118 patients with hip/knee OA who visited their GP or physical therapist were selected. Descriptive statistics were used to compare the content of care in GP-referred and self-referred patients to physical therapy. Results Content of care performed by GPs mostly concerned consultations, followed by NSAID prescriptions and referrals to secondary care. Both prescriptions of acetaminophen and referrals to physical therapy respectively dietary therapy were rarely mentioned. Nevertheless, still 65% of the patients in physical therapy practice were referred by their GP. Compared to GP-referred patients, self-referred patients more often presented recurrent complaints and were treated less often by activity-related exercise therapy. Education was rarely registered as singular intervention, neither in GP-referred nor in self-referred patients. Conclusion In accordance with the SCS, less advanced interventions are more often applied than more advanced interventions. To optimize the adherence to the SCS, GPs could reconsider the frequent use of NSAIDs instead of analgesics and the low referral rate to allied health care. Self-referral to physical therapy partially distorts both the low referral rate in general practice and the low application rate of education as singular intervention in physical therapy practice. Further research is recommended to evaluate the effects of task-shifting in OA care, taking into account the content of the SCS.
机译：背景技术最近已开发出一种基于多学科，基于指南的阶梯式护理策略（SCS），以改善髋和膝骨关节炎（OA）的管理。迄今为止，就护理内容和护理顺序而言，目前荷兰OA护理在多大程度上与SCS一致尚不清楚。此外，根据SCS，关于不同医疗保健提供者在OA护理中的作用尚不明确。因此，本研究的主要目的是描述髋/膝骨关节炎患者的初级保健内容，包括对SCS的依从性，并考虑到患者自我转诊进行物理治疗的情况。方法数据来自NIVEL基层医疗数据库。总共选择了12.118例行GP或理疗师治疗的髋/膝OA患者。描述性统计数据用于比较GP推荐患者和自我推荐患者物理治疗的护理内容。结果全科医生执行的护理内容主要涉及咨询，然后是NSAID处方和转诊至二级护理。很少提及对乙酰氨基酚的处方和分别推荐给物理疗法的饮食疗法。尽管如此，仍然有65％的物理治疗患者由其GP转诊。与GP推荐的患者相比，自我推荐的患者更经常出现反复不适，而活动相关的运动疗法则更少接受治疗。不论是在GP推荐患者还是在自我推荐患者中，教育很少被注册为单一干预措施。结论根据SCS，较高级的干预措施要比较高级的干预措施更多地采用。为了优化对SCS的依从性，GP可以重新考虑NSAID的频繁使用而不是止痛药的使用以及对相关医疗机构的转诊率低。自我推荐物理疗法会部分扭曲一般实践中的低推荐率和作为物理疗法实践中的单一干预手段的低教育应用率。考虑到SCS的内容，建议进行进一步的研究以评估任务转移在OA护理中的效果。

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