How has the OSD affected our state hospitals?

The long-awaited occupation-specific dispensation (OSD) process for state-employed doctors has now been concluded. The final offer, signed and accepted in the bargaining chamber despite being rejected by 92% of doctors in a SAMA survey, has not received much attention or fanfare. At the conclusion of this process, which has been drawn out over several years, many points have emerged that are extremely worrying for the future of health care in this country

Optimising the non-surgical care for knee osteoarthritis in primary care

Osteoarthritis (OA) is the most common joint disorder worldwide. This slow degenerative disease mainly affects knees, hips or hands. It is the 11th highest contributor to global disability on the WHO list because it often leads to pain, impaired mobility and stiffness in adults and elderly. Worldwide approximately 250 million people (3.6% of the global population) have knee OA. The prevalence of symptomatic knee OA in the United States is already 16.7% at the age of 45, respectively 13.5% in men and 18.7% in women. Obesity, female sex, increasing age and previous knee injury are important risk factors for knee OA. Knee OA will probably become a more imminent problem in the near future because life expectancy and obesity are increasing worldwide. In the Netherlands demographics suggest that OA-patients will grow with 40% between 2011 and 2030, worldwide even with 52% by 2040. The overall aim of this study is to improve the management of knee OA in primary care in Flanders. In order to improve the knee OA management, we first have to evaluate the magnitude of the problem and current care. Subsequently, the current care has to be compared with optimal care as described in evidence based guidelines. In addition, barriers and facilitators for optimal guideline adherence have to be explored and analyzed. Finally, this information makes it possible to develop specific intervention tools to improve guideline adherence and optimize care. Evaluation of these tailored interventions should gain more insight into the feasibility to improve knee OA management in primary care.status: publishe

The epidemiology of knee osteoarthritis in general practice: a registry-based study

OBJECTIVES: The present study investigated (1) trends in the prevalence and incidence of knee osteoarthritis over a 20-year period (1996-2015); (2) trends in multimorbidity and (3) trends in drug prescriptions. DESIGN: Registry-based study. SETTING: Primary healthcare, Flanders, Belgium. PARTICIPANTS: Data were collected from Intego, a general practice-based morbidity registration network. In the study period between 1996 and 2015, data from 440 140 unique patients were available. OUTCOME MEASURES: Trends in prevalence and incidence rate of knee osteoarthritis were computed using joinpoint regression analysis. The mean disease count was calculated to assess trends in multimorbidity. In addition, the number of drug prescriptions was identified by the Anatomical Therapeutic Chemical Classification code and trends were equally recorded with joinpoint regression. RESULTS: The total age-standardised prevalence of knee osteoarthritis increased from 2.0% in 1996 to 3.6% in 2015. An upward trend was observed with an average annual percentage change (AAPC) of 2.5 (95% CI 2.2 to 2.9). In 2015, the prevalence rates in the 10 year age groups from the 45-54 years age group onwards were 3.1%, 5.6%, 9.0% and 13.9%, to reach 15.0% in people aged 85 years and older. The incidence remained stable with 3.75‰ in 2015 (AAPC=-0.5, 95% CI -1.4 to 0.5). The mean disease count significantly increased from 1.63 to 2.34 (p<0.001) for incident cases with knee osteoarthritis. Finally, we observed a significantly positive trend in the overall prescription of acetaminophen (AAPC=6.7, 95% CI 5.6 to 7.7), weak opioids (AAPC=4.0, 95% CI 0.9 to 7.3) and glucosamine (AAPC=8.6, 95% CI 2.4 to 15.1). Oral non-steroidal anti-inflammatory drugs were most prescribed, with a prevalence rate of 29.8% in 2015, but remained stable during the study period (AAPC=0.0, 95% CI -1.1 to 1.1). CONCLUSIONS: Increased prevalence, multimorbidity, and number of drug prescriptions confirm an increased burden of knee osteoarthritis. In future, these trends can be used to prioritise initiatives for improvement in care.status: accepte

Intervention stuyd_primary care_educational outreach vistis for knee osteoarthritis

This file contains the original dataset to reproduce the outcome

Are physiotherapists adhering to quality indicators for the management of knee osteoarthritis? An observational study

Osteoarthritis (OA) is a common musculoskeletal condition that often leads to pain, stiffness and disability. Physiotherapy plays an important role in the management of knee OA, however we hypothesize discordance between physiotherapists' practice and existing guideline recommendations.status: publishe

The effect of electronic audits and feedback in primary care and factors that contribute to their effectiveness: a systematic review.

PURPOSE: The aim of this systematic review was (i) to assess whether electronic audit and feedback (A&F) is effective in primary care and (ii) to evaluate important features concerning content and delivery of the feedback in primary care, including the use of benchmarks, the frequency of feedback, the cognitive load of feedback and the evidence-based aspects of the feedback. DATA SOURCES: The MEDLINE, Embase, CINAHL and CENTRAL databases were searched for articles published since 2010 by replicating the search strategy used in the last Cochrane review on A&F. STUDY SELECTION: Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias. Our search resulted in 8744 records, including the 140 randomized controlled trials (RCTs) from the last Cochrane Review. The full texts of 431 articles were assessed to determine their eligibility. Finally, 29 articles were included. DATA EXTRACTION: Two independent reviewers extracted standard data, data on the effectiveness and outcomes of the interventions, data on the kind of electronic feedback (static versus interactive) and data on the aforementioned feedback features. RESULTS OF DATA SYNTHESIS: Twenty-two studies (76%) showed that electronic A&F was effective. All interventions targeting medication safety, preventive medicine, cholesterol management and depression showed an effect. Approximately 70% of the included studies used benchmarks and high-quality evidence in the content of the feedback. In almost half of the studies, the cognitive load of feedback was not reported. Due to high heterogeneity in the results, no meta-analysis was performed. CONCLUSION: This systematic review included 29 articles examining electronic A&F interventions in primary care, and 76% of the interventions were effective. Our findings suggest electronic A&F is effective in primary care for different conditions such as medication safety and preventive medicine. Some of the benefits of electronic A&F include its scalability and the potential to be cost effective. The use of benchmarks as comparators and feedback based on high-quality evidence are widely used and important features of electronic feedback in primary care. However, other important features such as the cognitive load of feedback and the frequency of feedback provision are poorly described in the design of many electronic A&F intervention, indicating that a better description or implementation of these features is needed. Developing a framework or methodology for automated A&F interventions in primary care could be useful for future research.status: publishe

Quality of Care for Knee Osteoarthritis in Primary Care: A Patient's Perspective

OBJECTIVE: To describe the quality of osteoarthritis care in general practice from a patient's perspective and to identify novel associations between process quality indicators and patient-reported outcome and experience measures. METHODS: For this study, 235 individuals with knee osteoarthritis completed a survey based on both process and outcome indicators. Process indicators were extracted from international guidelines and included the domains: diagnosis, self-management, treatment, and follow-up. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and RAND 36-item Short Form health survey (SF-36) were used to assess patient-reported outcomes. Patient-reported experience with care was evaluated with the European Task Force on Patient Evaluations of General Practice Care (EUROPEP) instrument. A series of multilevel regression analyses were then performed to analyze determinants at the patient level (i.e., age, sex, body mass index, and education) and associations between process and outcome indicators. RESULTS: Overall, low adherence to the process indicators was observed (38%), particularly on informing patients about the importance of weight loss (24% [95% confidence interval (95% CI) 19-31]) or referring them for physical therapy (41% [95% CI 33-49]). Patients described their quality of life as moderate, with an overall score of 63% and 35% on the SF-36 and WOMAC surveys, respectively. Regarding the determinants, patients with a higher education level were better informed (odds ratio [OR] 3.4; P = 0.0003). Associations between process and outcome indicators were scarce, with the exception of patient satisfaction with care and use of nonsteroidal antiinflammatory drugs (NSAIDs) (OR 2.9; P = 0.0014). CONCLUSION: Patients with knee osteoarthritis receive suboptimal conservative management. They report a moderate quality of life. This study confirms the evidence suggesting that NSAIDs are the backbone of osteoarthritis pain management but also adds evidence from a patient's perspective.status: publishe

Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective

Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.status: publishe

Educational outreach visits to improve knee osteoarthritis management in primary care

BACKGROUND: Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy. METHODS: An educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP. RESULTS: The intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group. CONCLUSIONS: This intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners' prescription behavior, more extensive or combined interventional approaches seem warranted.status: publishe