The Library

Referral recommendations for osteoarthritis of the knee incorporating patients' preferences

Tools

Musila, N., Underwood, M. (Martin) M.D., McCaskie, A. W., Black, N., Clarke, Aileen, 1955- and Meulen, J. H. van der. (2011) Referral recommendations for osteoarthritis of the knee incorporating patients' preferences. Family Practice, Vol.28 (No.1). pp. 68-74. ISSN 0263-2136

Preview

PDF
WRAP_Clarke_PubDocView.pdf - Published Version - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (183Kb)

Official URL: http://dx.doi.org/10.1093/fampra/cmq066

Abstract

Background. GPs have to respond to conflicting policy developments. As gatekeeper they are supposed to manage the growing demand for specialist services and as patient advocate they should be responsive to patients' preferences. We used an innovative approach to develop a referral guideline for patients with chronic knee pain that explicitly incorporates patients' preferences. Methods. A guideline development group of 12 members including patients, GPs, orthopaedic surgeons and other health care professionals used formal consensus development informed by systematic evidence reviews. They rated the appropriateness of referral for 108 case scenarios describing patients according to symptom severity, age, body mass, co-morbidity and referral preference. Appropriateness was expressed on scale from 1 (‘strongly disagree’) to 9 (‘strongly agree’). Results. Ratings of referral appropriateness were strongly influenced by symptom severity and patients' referral preferences. The influence of other patient characteristics was small. There was consensus that patients with severe knee symptoms who want to be referred should be referred and that patient with moderate or mild symptoms and strong preference against referral should not be referred. Referral preference had a greater impact on the ratings of referral appropriateness when symptoms were moderate or severe than when symptoms were mild. Conclusions. Referral decisions for patients with osteoarthritis of the knee should only be guided by symptom severity and patients' referral preferences. The guideline development group seemed to have given priority to avoiding inefficient resource use in patients with mild symptoms and to respecting patient autonomy in patients with severe symptoms.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Warwick Evidence Faculty of Medicine > Warwick Medical School > Health Sciences
Library of Congress Subject Headings (LCSH):	Osteoarthritis -- Treatment, Medical referral, Physician practice patterns
Journal or Publication Title:	Family Practice
Publisher:	Oxford University Press
ISSN:	0263-2136
Date:	February 2011
Volume:	Vol.28
Number:	No.1
Page Range:	pp. 68-74
Identification Number:	10.1093/fampra/cmq066
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	08/1310/72 (NIHR)
References:	1 National Institute for Clinical Excellence. Referral Advice—A guide to Appropriate Referral from General to Specialist Services. London: NICE, 2001. 2 National Institute of Clinical Excellence. Osteoarthritis: National Clinical Guideline for Care in Adults. London: NICE, 2008. 3 Davies M, Elywn G. Referral management centres: promising innovations or Trojan horses? BMJ 2006; 332: 844–6. 4 Department of Health. Building on the Best: Choice Responsiveness and Equity in the NHS. London: HMSO, 2003. 5 Raine R, Black N, Sanderson C. Developing clinical guidelines: a challenge to current methods. BMJ 2005; 331: 631–3. 6 National Joint Registry for England and Wales. Fourth Annual Report. NJR, 2007. 7 Fitch K, Bernstein SJ, Aguilar MS et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation, 2001. 8 McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 1993; 52: 258–62. 9 Dieppe PA, Cushnaghan J, Shepstone L. The Bristol ‘‘OA500’’ study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage 1997; 5: 87–97. 10 Hannan MT, Felson DT, Pincus T. Analysis of discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000; 27: 1513–7. 11 Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary healthcare. Ann Rheum Dis 2001; 60: 91–7. 12 Anderson JG, Wixson RL, Tsai D, Stulberg SD, Chang RW. Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthroplasty 1996; 11: 831–40. 13 Hawker G, Wright J, Coyte P et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am1998; 80: 163–73. 14 Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res 1998; 356: 93–110. 15 Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patients satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71: 262–7. 16 Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. AOA, 2006. 17 Edwards A, Elwyn G. Evidence-Based Patient Choice. Oxford: Oxford University Press, 2001. 18 Murphy MK, Black NA, Lamping DL et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess 1998; 2: 1–88. 19 Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Developing clinical guidelines. BMJ 1999; 318: 593–6. 20 Raine R, Sanderson C, HutchingsAet al. An experimental study of determinants of group judgments in clinical guideline development. Lancet 2004; 364: 429–37. 21 Woolhead GM, Donovan JL, Chard JA, Dieppe PA. Who should have priority for a knee joint replacement? Rheumatology 2002; 41: 390–4. 22 Naylor CD, Williams JI. Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority. Qual Health Care 1996; 5: 20–30. 23 Dieppe P, Basler HD, Chard J et al. Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology 1999; 38: 73–83. 24 Escobar A, Quintana JM, Aro´ stegui I et al. Development of explicit criteria for total knee replacement. Int J Technol Assess Health Care 2003; 19: 57–70. 25 Jones IR, Berney L, Kelly M et al. Is patient involvement possible when decisions involve scarce resources? A qualitative study of decision-making in primary care. Soc Sci Med 2004; 59: 93–102. 26 Department ofHealth. TheMusculoskeletal Services Framework—A Joint Responsibility: Doing It Differently. London: DH, 2006. 27 Clark JP, Hudak PL, Hawker GA et al. The moving target: a qualitative study of elderly patients' decision-making regarding total joint replacement surgery. J Bone Joint Surg Am 2004; 86: 1366–74.
URI:	http://wrap.warwick.ac.uk/id/eprint/44066