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

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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 > 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)
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URI:	http://wrap.warwick.ac.uk/id/eprint/44066

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