Healey Emma Louise, Afolabi Ebenezer K, Lewis Martyn, Edwards John J, Jordan Kelvin P, Finney Andrew, Jinks Clare, Hay Elaine M, Dziedzic Krysia S
Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK.
BMC Musculoskelet Disord. 2018 Aug 17;19(1):295. doi: 10.1186/s12891-018-2196-2.
Osteoarthritis (OA) is a leading cause of pain and disability. NICE OA guidelines (2008) recommend that patients with OA should be offered core treatments in primary care. Assessments of OA management have identified a need to improve primary care of people with OA, as recorded use of interventions concordant with the NICE guidelines is suboptimal in primary care. The aim of this study was to i) describe the patient-reported uptake of non-pharmacological and pharmacological treatments recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and ii) determine whether patient characteristics or OA diagnosis impact uptake.
A cross-sectional survey mailed to adults aged ≥45 years (n = 28,443) from eight general practices in the UK as part of the MOSAICS study. Respondents who reported the presence of joint pain, a consultation in the previous 12 months for joint pain, and gave consent to medical record review formed the sample for this study.
Four thousand fifty-nine respondents were included in the analysis (mean age 65.6 years (SD 11.2), 2300 (56.7%) females). 502 (12.4%) received an OA diagnosis in the previous 12 months. More participants reported using pharmacological treatments (e.g. paracetamol (31.3%), opioids (40.4%)) than non-pharmacological treatments (e.g. exercise (3.8%)). Those with an OA diagnosis were more likely to use written information (OR 1.57; 95% CI 1.26,1.96), paracetamol (OR 1.30; 95% CI 1.05,1.62) and topical NSAIDs (OR 1.30; 95% CI 1.04,1.62) than those with a joint pain code. People aged ≥75 years were less likely to use written information (OR 0.56; 95% CI 0.40,0.79) and exercise (OR 0.37; 95% CI 0.25,0.55) and more likely to use paracetamol (OR 1.91; 95% CI 1.38,2.65) than those aged < 75 years.
The cross-sectional population survey was conducted to examine the uptake of the treatments that are recommended in the NICE OA guidelines in older adults with a self-reported consultation for joint pain and to determine whether patient characteristics or OA diagnosis impact uptake. Non-pharmacological treatment was suboptimal compared to pharmacological treatment. Implementation of NICE guidelines needs to examine why non-pharmacological treatments, such as exercise, remain under-used especially among older people.
骨关节炎（OA）是导致疼痛和残疾的主要原因。英国国家卫生与临床优化研究所（NICE）的OA指南（2008年）建议，OA患者应在初级医疗保健中接受核心治疗。对OA管理的评估发现，需要改善OA患者的初级医疗保健，因为在初级医疗保健中，与NICE指南一致的干预措施的实际使用情况并不理想。本研究的目的是：i）描述在自我报告有关节疼痛的老年人中，患者报告的NICE OA指南中推荐的非药物和药物治疗的使用情况；ii）确定患者特征或OA诊断是否会影响治疗的使用。
作为MOSAICS研究的一部分，向英国8家全科诊所中年龄≥45岁的成年人（n = 28,443）邮寄了一份横断面调查问卷。报告有关节疼痛、在过去12个月内因关节疼痛进行过咨询且同意进行病历审查的受访者构成了本研究的样本。
4059名受访者纳入分析（平均年龄65.6岁（标准差11.2），2300名（56.7%）为女性）。502名（12.4%）在过去12个月内被诊断为OA。报告使用药物治疗（如对乙酰氨基酚（31.3%）、阿片类药物（40.4%））的参与者多于非药物治疗（如运动（3.8%））。与有关节疼痛记录的人相比，被诊断为OA的人更有可能使用书面信息（比值比1.57；95%置信区间1.26,1.96）、对乙酰氨基酚（比值比1.30；95%置信区间1.05,1.62）和外用非甾体抗炎药（比值比1.30；95%置信区间1.04,1.62）。与年龄<75岁的人相比，年龄≥75岁的人使用书面信息（比值比0.56；95%置信区间0.40,0.79）和运动（比值比0.37；95%置信区间0.25,0.55）的可能性较小，而使用对乙酰氨基酚的可能性较大（比值比1.91；95%置信区间1.38,2.65）。
本横断面人群调查旨在研究自我报告有关节疼痛的老年人对NICE OA指南中推荐治疗的使用情况，并确定患者特征或OA诊断是否会影响治疗的使用。与药物治疗相比，非药物治疗的情况不太理想。NICE指南的实施需要研究为何非药物治疗（如运动）的使用仍然不足，尤其是在老年人中。
