Osteoarthritis

Reports criticises GP over-reliance on medications for foot and ankle OA


People who consult a GP for foot and ankle OA are more likely to get a prescription for an opioid than a referral to an allied health professional, a national snapshot of treatment data has revealed.

Data from the long-running BEACH survey of GP-patient encounters shows that for foot and ankle OA consults, drug treatment rates far exceed those for conservative non-drug approaches recommended in evidence-based guidelines.

The findings, published in Osteoarthritis and Cartilage, are derived from data covering 621 GP-reported patient encounters for foot and ankle OA between 2010-2016 as part of the Bettering the Evaluation and Care of Health (BEACH) Program.

Contrary to previous reports that have suggested foot and knee OA is a common problem in primary  care, the data showed that rates of management were about one sixth of those reported for knee OA (1.06 vs 6.2 per 1000 patient encounters).

GPs mostly managed foot and knee OA with medications (64.6 times per 100 problems), with rates far exceeding non-drug strategies such as advice on self-management with exercise and weight loss  (17.7 per 100 encounters).

The medications prescribed were predominantly NSAIDs (38.7%), paracetamol (34.8%) and opioids (19.4%).

The report authors, from the University of Melbourne Department of Physiotherapy , said it was concerning that patients were more likely to get an opioid prescription than a referral to a physiotherapist after seeing a GP for foot and ankle OA.

“Furthermore, referrals to orthopaedic surgeons and to podiatrists were both made more frequently than to physiotherapists. Imaging referral rates were also high,” they noted.

The report authors said the low rates of GP management of foot and ankle OA compared to knee OA might be due to it being perceived as a low priority, despite its disabling pain and impeding weight bearing activities such as walking.

Previous studies have shown that patients often only mention their foot symptoms when consulting the GP for other problems, which are given greater priority.

“These findings are also consistent with accounts by patients with rheumatoid arthritis that their foot symptoms were often overlooked by  clinicians despite patients describing these symptoms as debilitating and/or disabling,” the report authors said.

“These findings suggest that greater efforts are needed to encourage the use of self-care and conservative management models, advised by international clinical guidelines for OA, when GPs manage foot/ankle OA in primary care,” they concluded.

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