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Osteoarthritis must be in QOF

Dr Garth Logan says the evidence and

the huge number of patients involved make an undeniably strong case

Osteoarthritis is a massive health issue which has an enormous impact on individuals, society and the health service.

It is the commonest form of arthritis and the biggest cause of disability in the elderly1. It has a more severe effect on quality of life than any other chronic condition and 81 per cent of patients with OA have constant pain or limitation in activity2. It accounts for two million GP consultations a year and 44,000 hip replacements.

Given these statistics, it's hard to argue that epilepsy, thyroid disease, and even COPD, diabetes and IHD are more important conditions. Maybe it's because it's hard to measure outcomes in the older population. Or maybe it's because doctors and patients still believe OA is just inevitable and there isn't much that can be done.

There is evidence to suggest a lot can be done to help people with OA improve and maintain their independence, reduce their pain levels, and prevent things from getting worse3,4. Furthermore it's all stuff that most GPs, perhaps with the help of a practice nurse and local patient-led support groups, can do, and it doesn't involve doling out lots of expensive drugs with awful or dangerous side-effects.

The Primary Care Rheumatology Society, supported by ARMA and the Primary Care Sciences Research Centre at Keele University, has submitted a proposal that OA hip and knee should be included as a new clinical area in the QOF.

Many of the indicators suggested relate to management and prevention of other long-term conditions such as cardiovascular disease, diabetes, etc. We have included seven clinical indicators (see box) which have been supported with 60 references to epidemiological evidence and high-quality research.

Attention is also drawn in the medication review to the appropriate use of analgesia and NSAIDs. This focus could reduce the burden on the NHS that arises from the overuse of NSAIDs in this mainly elderly population, in whom co-morbidity and serious adverse effects are common.

Given the reasonable level at which we have pitched the indicators, our submission makes a compelling case for their inclusion in the revised framework next April.

Garth Logan, president, Primary Care Rheumatology Society and a GP in Lisburn, Northern Ireland

Suggested indicators

1 The practice can produce a register of all patients with knee or hip OA

2 The percentage of patients with knee or hip OA who have ever been given written information on the nature and treatment of the condition

3 The percentage of patients

with knee or hip OA whose

notes record BMI in the last

15 months

4 The percentage of patients with knee or hip OA, with a BMI =30, whose records show advice on weight loss or referral to a dietitian, where available, has been offered in the last 15 months

5 The percentage of patients with knee or hip OA whose notes record an assessment of exercise (currently undertaken by the patient) in the last 15 months

6 The percentage of patients with knee or hip OA whose notes record that advice on exercise, or a referral to physiotherapy for advice or to an exercise referral scheme (if available), has been offered in the last 15 months

7 The percentage of patients with knee or hip OA who have had a medication review in the last 15 months

References

1 Sprangers MA et al. Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology. 2000;53(9): 895-907

2 OA Nation. Arthritis Care 2004 http://oanation.arthritiscare.org.uk/fileadmin/oanation/downloads/OA_Nation_report.pdf

3 Standards of Care for people with Osteoarthritis. Arthritis and Musculoskeletal Alliance. London, ARMA (2004)

4 Roddy E et al. Evidence-based recommendations for the

role of exercise in the management of osteoarthritis of the

hip or knee ­ the MOVE consensus.

Rheumatology 2005;44(1):67-73

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