Referral of people with osteoarthritis to self-management programmes: Barriers and enablers identified by general practitioners

Monash Institute of Health Services Research, Monash University, Clayton, Victoria, Australia.
Disability and Rehabilitation (Impact Factor: 1.99). 03/2008; 30(25):1938 - 46. DOI: 10.1080/09638280701774233
Source: PubMed


We conducted a qualitative descriptive study involving general practitioners (GPs) in Victoria, Australia, to examine the barriers to, and drivers of, referral of patients with osteoarthritis (OA) to self-management programmes.
Participating GPs were asked to respond to a series of open-ended questions regarding their referral of patients with OA to self-management programmes and their perception of the advantages and disadvantages of these programmes for people with OA. Interviews were audio-taped, transcribed verbatim, and analysed to identify primary themes in the data.
Results suggest current referral of OA patients to self-management programmes from within general practice is influenced by GP-related factors, patient-related factors, and programme-related factors. A major barrier to referral was GPs limited knowledge about the availability of local programmes and the types of services these programmes provide to people with OA. Some GPs felt OA is less conducive to self-management interventions compared to other chronic conditions (e.g., diabetes, asthma) and questioned the clinical benefit of programmes for people with OA. Enablers of GP referral included GP knowledge about content and availability of programmes, positive GP attitudes towards patient involvement in these programmes, and patient awareness of the value and availability of these programmes (i.e., patient-mediated referral).
This study suggests multiple barriers and drivers of referral of patients with OA to self-management programmes that could be targeted in the future in order to increase referral to, and uptake of, these programmes in general practice.

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    • "GPs feel that patient led follow up is appropriate [23], particularly if they also hold the view that OA is ‘not a disease’ [35]. Interestingly, this belief seemed to underpin a reluctance to refer to self-management programmes, with GPs not identifying OA a chronic disease with the same standing as diabetes, but as a condition with little or no opportunity for modification of outcomes [36]. "
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    ABSTRACT: Osteoarthritis (OA) is a common cause of disability and consultation with a GP. However, little is known about what currently happens when patients with OA consult their GP. This review aims to compare existing literature reporting patient experiences of consultations in which OA is discussed with GP attitudes and beliefs regarding OA, in order to identify any consultation events that may be targeted for intervention. After a systematic literature search, a narrative review has been conducted of literature detailing patient experiences of consulting with OA in primary care and GP attitudes to, and beliefs about, OA. Emergent themes were identified from the extracted findings and GP and patient perspectives compared within each theme. Twenty two relevant papers were identified. Four themes emerged: diagnosis; explanations; management of the condition; and the doctor-patient relationship. Delay in diagnosis is frequently reported as well as avoidance of the term osteoarthritis in favour of 'wear and tear'. Both patients and doctors report negative talk in the consultation, including that OA is to be expected, has an inevitable decline and there is little that can be done about it. Pain management appears to be a priority for patients, although a number of barriers to effective management have been identified. Communication within the doctor patient consultation also appears key, with patients reporting a lack of feeling their symptoms were legitimised. The nature of negative talk and discussions around management within the consultation have emerged as areas for future research. The findings are limited by generic limitations of interview research; to further understanding of the OA consultation alternative methodology such as direct observation may be necessary.
    BMC Family Practice 03/2014; 15(1):46. DOI:10.1186/1471-2296-15-46 · 1.67 Impact Factor
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    • "1.4.2. Practitioners' promoting or not self-management programs for people with osteoarthritis A qualitative descriptive study [43] to identify barriers to physicians' referring patients to OA self-management programs was conducted in Australia. General practitioners (GPs) limiting knowledge about the availability of local programs and the types of services that these programs provide was a major barrier to referral for OA patients. "
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    ABSTRACT: To assess therapeutic education program impact for lower limb osteoarthritis (OA) at both the medical and surgical stage. Factors limiting efficiency and implementation of these programs such as patients' beliefs will be highlighted. A non systematic literature review on Medline and Cochrane Library databases from 1966 to 2009 using following key words "knee/hip osteoarthritis", "self-care/therapeutic education", "total hip/knee replacement/arthroplasty", "patients' beliefs" is conducted. Clinical trials and randomized clinical trials, as well as literature reviews and practice guidelines, published in English and French will be analysed. Therapeutic education is part of the non-pharmacological management of chronic illnesses such as OA. The aim of education at an early stage of OA is to change patients' lifestyle, especially the regular practice of physical activity and weight reduction. Fears and avoidance assessment is necessary before patients' education process. When a surgical option is considered, the aim of education is to hasten patient recovery, improve autonomy after surgery, facilitate the return home and reduce the rate of transfer to a rehabilitation unit. The efficacy of therapeutic education could be optimised for the management of OA with use of standardized rules and methods to deliver information and education. One way to improve therapeutic education in the management of OA could be to propose dedicated continuing medical education programs supported by specific economic sources for health care professionals.
    Annals of physical and rehabilitation medicine 08/2010; 53(6-7):434-50. DOI:10.1016/

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