Impact of physician specialty on classification of physician-perceived patient severity for patients with osteoarthritis

Opioid Prescribing for Osteoarthritis: Cross-Sectional Survey among Primary Care Physicians, Rheumatologists, and Orthopaedic Surgeons

Opioids are often prescribed for osteoarthritis (OA) pain, despite recommendations to limit use due to minimal benefits and associated harms. This study aimed to assess physicians' practice patterns and perceptions regarding opioids by specialty one year following the Centers for Disease Control and Prevention (CDC) published guidance on opioid prescribing. The 139/153 (90.8%) physicians who reported prescribing opioids in the previous year reported decreased prescribing for mild OA (51.3%, 26.5% and 33.3% of primary care physicians, rheumatologists, and orthopaedic surgeons, respectively), moderate OA (50.0%, 47.1% and 48.1%) and severe OA (43.6%, 41.2% and 44.4%). Prescribing changes were attributed to the CDC guidelines for 58.9% of primary care physicians, 59.1% of rheumatologists, and 73.3% of orthopaedic surgeons. Strong opioids were mostly reserved as third-line treatment. Although treatment effectiveness post-CDC guidelines was not assessed, perceptions of efficacy and quality of life with opioids significantly differed across specialties, whereas perceptions of safety, convenience/acceptability and costs did not. Physicians generally agreed on the barriers to opioid prescribing, with fear of addiction and drug abuse being the most important. Across specialties, physicians reported decreased opioid prescribing for OA, irrespective of OA severity, and in most cases attributed changes in prescribing to the CDC guideline.

Factors associated with physician-reported treatment status of patients with osteoarthritis pain

BACKGROUND

Osteoarthritis (OA) is typically associated with pain, but many patients are not treated.

METHODS

This point in time study explored factors associated with treatment status, using logistic regression of data from the Adelphi OA Disease Specific Programme conducted in the United States. Patients' treatment status was based on physician-reported, current: 1) prescription medication for OA vs. none; and 2) physician treatment (prescription medication and/or recommendation for specified nonpharmacologic treatment for OA [physical or occupational therapy, acupuncture, transcutaneous electrical nerve stimulation, or cognitive behavior therapy/psychotherapy]) vs. self-management (no prescription medication or specified nonpharmacologic treatment).

RESULTS

The 841 patients (including 57.0% knee OA, 31.9% hip OA) reported mild (45.4%) or moderate or severe (54.6%) average pain intensity over the last week. The majority were prescribed medication and/or recommended specified nonpharmacologic treatment; 218 were not prescription-medicated and 122 were self-managed. Bivariate analyses showed less severe patient-reported pain intensity and physician-rated OA severity, fewer joints affected by OA, lower proportion of joints affected by knee OA, better health status, lower body mass index, and lower ratings for cardiovascular and gastrointestinal risks, for those not prescribed medication (vs. prescription-medicated). Multivariate analyses confirmed factors significantly (p < 0.05) associated with prescription medication included (odds ratio): physician-rated current moderate OA severity (vs. mild, 2.03), patient-reported moderate OA severity 6 months ago (vs. mild, 1.71), knee OA (vs. not, 1.81), physician-recommended (0.28) and patient-reported (0.43) over-the-counter medication use (vs. not), prior surgery for OA (vs. not, 0.37); uncertain income was also significant. Factors significantly (p < 0.05) associated with physician treatment included (odds ratio): physician-recommended nonpharmacologic therapy requiring no/minimal medical supervision (vs. not, 2.21), physician-rated current moderate OA severity (vs. mild, 2.04), patient-reported over-the-counter medication use (vs. not, 0.26); uncertain time since diagnosis was also significant. Patient-reported pain intensity and most demographic factors were not significant in either model.

CONCLUSIONS

Approximately 1 in 4 patients were not prescribed medication and 1 in 7 were self-managed, although many were using over-the-counter medications or nonpharmacologic therapies requiring no/minimal medical supervision. Multiple factors were significantly associated with treatment status, including OA severity and over-the-counter medication, but not pain intensity or most demographics.

Characteristics of People with Hip or Knee Osteoarthritis Deemed Not Yet Ready for Total Joint Arthroplasty at Triage

PURPOSE

To identify the characteristics of people with hip or knee osteoarthritis (OA) attending a regional triage centre for an initial consult who are deemed not yet ready for total joint arthroplasty (TJA).

METHODS

Initial consultation notes (n=482) were reviewed retrospectively. Predictive variables were derived from the literature a priori, and 14 of these variables were suitable for inclusion in stepwise multiple logistic regression analyses.

RESULTS

Of the 222 eligible people, 131 (59%) were deemed not yet ready for TJA. Five variables entered into the model ([Formula: see text]=133.19, p<0.001) for an overall success rate of 81.1%. Those deemed not yet ready for TJA were more likely to have knee OA (vs. hip OA; odds ratio [OR]=0.352, p=0.018), to have less severe OA (OR=0.246 for each category increase in severity, p<0.001), to use no gait aid (vs. cane; OR=0.390, p=0.033), and to have a higher Lower Extremity Functional Scale score (OR=1.050 for each 1-point increase, p=0.003) and better joint status as measured by the Knee Society Scale or Hip Harris Scale (OR=3.946 for each category increase, p=0.007).

CONCLUSION

Considering these characteristics will help clinicians to identify individuals likely to require interventions other than TJA.