Article Figures & Data
Figures
- Figure 1
Patient recruitment and selection of index consultations.
GP = general practitioner; OA = osteoarthritis
Tables
Inclusion GP used terms wear and tear, arthritis, or osteoarthritis diagnostically. GP gave no diagnosis, but findings support diagnosis of OA based on criteria recommended by the UK National Institute for Health and Care Excellence (NICE) OA Guideline Development Group18:
• Persistent joint pain worse with use
• Patient aged 45 years and over
• Morning stiffness lasting no more than 30 minutesExclusion GP diagnosed a regional soft tissue problem or a generalized soft tissue problem such as fibromyalgia. GP gave no diagnosis, but the researcher felt a soft tissue diagnosis to be more likely than OA. Inflammatory arthritis (or suspected inflammatory arthritis) was apparent during consultation or present on medical record if the researcher’s clinical suspicion prompted a review of the record. Malignancy was apparent during consultation or present on the medical record. GP referred the patient to secondary care because of diagnostic uncertainty. Patient had only spinal symptoms. GP = general practitioner; OA = osteoarthritis, UK = United Kingdom.
Consultation No. Patient Demographics Joint(s) Discussed in Order Presented, Most Symptomatic in Bolda New Problem or Follow-upb OA-Related Read Codec Joint Pain Primary or Secondary Complaintd Other Problems Discussed, No. Consultation Length, min Age Sex Total Time on OA (%) 1 62 Female Hip, knee, back Follow-up No Primary 3 14:10 08:46 (61.9) 2 65 Male Hip, back Follow-up Yes Secondary 1 07:00 05:56 (84.8) 3 75 Female Shoulder, neck, knee Follow-up Yes Primary 0 16:14 16:14 (100) 4 69 Male Knee New Yes Secondary 2 12:44 01:00 (7.9) 5 70 Male Knee Follow-up Yes Primary 0 12:17 12:17 (100) 6 79 Male Neck, hip New Yes Secondary 3 10:44 01:51 (17.2) 7 65 Female Knee, hip New No Secondary 2 13:36 00:45 (5.5) 8 49 Male Knee New No Secondary 4 20:23 10:72 (54.9) 9 67 Female Hip Follow-up Yes Secondary 1 06:40 01:15 (18.8) 10 75 Female Hip, knee New Yes Secondary 4 12:16 00:50 (6.8) 11 74 Female Knee Follow-up Yes Secondary 3 18:29 01:49 (9.8) 12 79 Female Knees, hip Follow-up Yes Primary 0 08:36 08:36 (100) 13 72 Female Knee Follow-up Yes Secondary 1 09:21 02:37 (28) 14 65 Male Knee New No Primary 2 10:05 8:05 (80.2) 15 65 Female Hip New No Secondary 3 12:53 01:10 (9.1) 16 61 Female Knee Follow-up Yes Secondary 2 08:49 06:00 (68.1) 17 84 Female Knee Follow-up Yes Secondary 4 22:42 00:25 (1.8) 18 62 Female Hands, feet New No Primary 0 09:44 09:44 (100) 19 85 Female Knee Follow-up Yes Primary 1 20:20 20:00 (98.4) OA = osteoarthritis
↵a Spinal pain was not the focus of the study, and patients with spinal pain only were excluded. It is mentioned here where spinal symptoms were discussed in conjunction with peripheral joint OA to illustrate how many patients had multisite pain. Areas of spinal pain listed in this column are italicized.
↵b New in this column indicates that the patient had either not discussed the most symptomatic joint with the GP before (data derived from the medical record and patient report) or that the patient was seeing the GP for results following the first consultation.
↵c Evidence of previous medical record entry of OA in any joint.
↵d Primary complaint is defined as the first presenting complaint mentioned to the GP in the consultation.
- Table 3
Barriers to Use of the Term Osteoarthritis and the Discussion of Osteoarthritis Identified in This Study
The predominance of the societal construct of OA that suggests it is part of normal life/aging process Omission of OA in the UK government-led quality of care initiative Limited or uneven access to treatment resources such as physical therapy Lack of knowledge about the prognosis of OA Lack of clear language for positive diagnosis and explanation of OA Inconsistent interpretation of language in radiology reports Concern that diagnosis may result in harm or adoption of “sick role” OA = Osteoarthritis; UK = United Kingdom
Supplemental Appendix
Supplemental Appendix. Quotations to illustrate themes
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall
Zoe Paskins , and colleagues
Background Both patients and physicians report dissatisfaction with primary care visits relating to osteoarthritis (OA), the most common cause of musculoskeletal pain in older adults. This study aims to identify how to improve care delivery for OA by investigating the language, explanations, and exchanges that occur in these visits. It does so by observing 19 real-life OA visits and interviewing physicians and patients using video-stimulated recall.
What This Study Found There is confusion between patients and doctors about what OA is and its priority among patients' multiple medical conditions. There is little OA-related discussion during patient visits and minimal provision of information. Doctors frequently normalize symptoms of OA as part of life and reassure patients who are not seeking reassurance.
Implications
- The authors call for addressing OA's identity crisis by developing a clearer medical language with which to explain the condition in the primary care visit.
Annals Journal Club
Nov/Dec 2015: The Identity Crisis of Osteoarthritis
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Discussion: Submit a comment.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
Paskins Z, Sanders T, Croft P, Hassell A. The identity crisis of osteoarthritis in general practice: a qualitative study using video-stimulated recall. Ann Fam Med. 2015;13(6):537-544..
Discussion Tips
Rarely do we get a chance to reflect on both the patient and the clinician perspective on the care we provide. This study uses videotapes of visits between patients and their general practice physicians to stimulate interpretations from both parties, and then carefully draws the cross-cutting lessons.
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question?
- To what degree can the findings be accounted for by:
- How participants were selected?
- Saturation (additional sampling doesn't yield substantial new information)?
- How the data were analyzed?
- How the findings were interpreted?
- What are the main study findings? What general and osteoarthritis-specific communication issues are identified?
- How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? Policy? Education? Research?
- Who are the constituencies for the findings, and how might they might be engaged in interpreting or using the findings?
- What are the next steps in interpreting or applying the findings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197 http://annfammed.org/content/4/3/196.full.
In this issue
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- Barriers and enablers to the management of osteoarthritis in primary care in Ireland from the perspective of healthcare professionals and individuals with osteoarthritis: a qualitative study using the Theoretical Domains Framework
- Improving osteoarthritis care in family practice
- "It ... doesnt always make it [to] the top of the list": Primary care physicians experiences with prescribing exercise for knee osteoarthritis
- Patterns of routine primary care for osteoarthritis in the UK: a cross-sectional electronic health records study
- In This Issue: Multilevel Effects
- The Identity Crisis of Osteoarthritis