Table 4.
Statements excluded from the model OA consultation
|
Statement |
No. (%) GP group would include (n = 15) |
No. (%) Patient group would include (n = 14) |
|---|---|---|
| The GP:* | ||
| Assesses the degree of pain using a formal measure, such as rating the pain on a scale from 0 to 10 |
1 (7) |
8 (57) |
| Assesses the extent of mobility problems using a formal measure, such as a rating scale from 0 to 10. |
1 (7) |
7 (50) |
| Asks about a family history of joint problems |
6 (43) |
4 (29) |
| Asks about jobs which may have affected/caused the knee problem, such as those involving a lot of kneeling (for example, carpet fitter, cleaner, joiner, electrician) |
9 (64) |
5 (36) |
| Asks about the patient’s expectations of the consultation |
10 (67) |
4 (31) |
| Asks which problem, concerning the knee, the patient wants help with most, for example pain, stiffness or climbing the stairs |
9 (60) |
5 (38) |
| Asks about who the patient has seen, or asked for help from, about the problem |
10 (71) |
6 (46) |
| Assesses the patient’s mood for symptoms of anxiety and depression |
8 (53) |
1 (8) |
| Screens the patient for depression using a formal depression screening tool |
0 (0) |
0 (0) |
| Asks about other conditions, such as diabetes, heart or kidney disease, which might affect the management of the knee problem |
10 (67) |
9 (64) |
| Asks about circumstances, such as unemployment and financial hardship, which might affect the management of the knee problem |
5 (33) |
0 (0) |
| Assesses the knee joint by general observation of the patient’s walking pattern, mobility and footwear |
13 (87) |
9 (69) |
| Performs a specific test, such as a timed walk test, to assess function |
0 (0) |
3 (21) |
| Examines the other knee, hips and hands for signs of osteoarthritis |
11 (73) |
10 (71) |
| If not recently done, measures weight and height to calculate the body mass index |
6 (40) |
6 (46) |
| Undertakes a full examination of the locomotor system (of the joints and muscles) |
0 (0) |
4 (33) |
| Enquires about the patient’s views and understanding of osteoarthritis |
13 (87) |
9 (75) |
| In addition to giving a brief explanation explains the likely cause of osteoarthritis |
4 (27) |
9 (69) |
| In addition to giving a brief explanation explains the likely outcome for people with osteoarthritis |
9 (60) |
8 (62) |
| Explores the patient’s understanding of the information given, and their reaction/beliefs/feelings about it |
8 (53) |
8 (62) |
| Tells the patient that they are central to the management of their own condition: that self-management of osteoarthritis is necessary and important |
13 (87) |
11 (85) |
| Explains that the central role of the primary healthcare team in the management of osteoarthritis is to support and guide self-management |
7 (47) |
9 (69) |
| Explains the purpose of managing osteoarthritis to: improve understanding, reduce pain, improve mobility and reduce the risk of it getting worse |
9 (60) |
12 (86) |
| Explains the approach to the treatment of osteoarthritis recommended by NICE |
3 (20) |
8 (62) |
| In addition to handing out the guidebook highlights sections in the guidebook relevant to the patient’s problem |
6 (40) |
6 (46) |
| Asks if the patient has any views/preferences for what treatment they might want to consider next, and, if they do, what they are |
12 (80) |
6 (43) |
| Takes an “exercise history”: the patient’s attitude to taking exercise/physical activity/exercises and their experience of these |
9 (60) |
6 (43) |
| Takes a “weight history”: the patient’s attitude to losing weight and their prior experience of doing this |
7 (47) |
9 (69) |
| Indicates, if the patient is overweight, where they are on a body mass index chart |
7 (47) |
9 (69) |
| Explains that exercise may cause muscle soreness initially and that the benefits of exercise may not be immediate |
9 (60) |
5 (38) |
| Explains the risks and benefits of painkillers |
11 (73) |
6 (50) |
| Discusses with the patient whether any other extra treatment needs to be considered |
7 (47) |
8 (67) |
| Discusses appropriate referrals, for example to; physiotherapy, occupational therapy, podiatry, social services, community pharmacy, district nursing service or work support services |
8 (53) |
10 (71) |
| Discusses the option of joint replacement surgery in patients with established severe pain, or severe functional limitation, in addition to core treatments and painkillers |
7 (47) |
7 (54) |
| Formulates with the patient a self-management plan |
11 (73) |
10 (77) |
| Explains when the patient should re-consult the GP | 11 (73) | 8 (57) |
* “The GP” is the stem for all the statements.