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Management of Osteoarthritis of the Knee by Primary Care Physicians
Lorrie A. Mamlin, MPH;
Catherine A. Melfi, PhD;
Michael L. Parchman, MD;
Benjamin Gutierrez, PhD;
Deborah I. Allen, MD;
Barry P. Katz, PhD;
Robert S. Dittus, MD;
David A. Heck, MD;
Deborah A. Freund, PhD
Arch Fam Med. 1998;7:563-567.
Background Most patients with osteoarthritis (OA) are treated by primary care physicians (in this article, primary care physicians are family physicians and general internists).
Objective To describe and compare the self-reported practice patterns of family physicians and general internists for the evaluation and management of severe OA of the knee, including factors that might influence referral for total knee replacement.
Design, Setting, and Participants A survey was developed and mailed to randomly selected community family physicians and general internists practicing in Indiana.
Main Outcome Measure Self-reported physician practice patterns regarding OA of the knee.
Results Physical examination was the most common method of evaluating OA of the knee. Family physicians were more likely to examine for crepitation, joint stability, and quadriceps muscle strength than were general internists (P<.05). Patients with OA of the knee treated by family physicians were more likely to receive nonsteroidal anti-inflammatory drugs or oral corticosteroids and were less likely to receive aspirin, acetaminophen, or narcotics compared with patients treated by general internists. Six patient characteristics were rated as positive factors favoring a referral for possible total knee replacement, 8 characteristics were rated as negative, and 5 were rated as not a factor in the decision about referral.
Conclusions Results from this study suggest that additional research is needed to determine the evaluative techniques for OA of the knee that provide the most useful information for management decisions, the management techniques that maximize patient outcomes, and the criteria that should be used to select patients who would benefit most from referral for possible total knee replacement.
From the Bowen Research Center, Indiana University, Indianapolis (Ms Mamlin and Drs Melfi, Parchman, Gutierrez, Allen, Dittus, and Freund); the Center for Health Services Research, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (Ms Mamlin); the Divisions of General Internal Medicine (Ms Mamlin and Dr Dittus) and Biostatistics (Drs Melfi and Katz), Department of Medicine, the Department of Family Medicine (Drs Parchman and Allen), and the Department of Orthopaedic Surgery (Dr Heck), Indiana University School of Medicine, Indianapolis; Health Services and Policy Research, Lilly Research Laboratories, Indianapolis (Dr Melfi); the Department of Family Medicine, University of Texas at El Paso (Dr Parchman); the Regenstrief Institute for Health Care, Indianapolis (Dr Dittus); and the School of Public and Environmental Affairs, Indiana University, Bloomington (Dr Freund).
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