New Insights into the Primary Care Osteoarthritis Consultation with Implications for Practice

Background/Purpose Osteoarthritis (OA) is the commonest long term condition in primary care. Existing international guidance suggests that much can be done to improve patient outcomes but existing research suggests doctors and patients are pessimistic about OA treatment. How important is the primary care consultation in shaping and influencing this incongruity? Our study used innovative methods, a combination of video recorded consultations and post consultation interviews using video to prompt recall, to uncover what happens when patients with OA present to their General Practitioners (GPs). The study took place in the context of a programme of translational research and also aimed to characterise any unmet patient need to which interventions could be targeted. Methods With ethical approval, 15 GPs consented to have two routine consultation sessions video recorded. GP consultations with 190 consenting patients aged ≥ 45 were video recorded. 20 consultations contained reference to OA, and 17 of these patients and their GPs (n=13) consented to participate in post consultation interviews, during which the video was played to stimulate recall. Analysis involved comparing and contrasting patient and GP interviews with the matched consultation findings, using thematic analysis. The results in this abstract relate predominantly to the consultation findings. Results Four overarching themes emerged from analysis: complexity, heterogeneity, dissonance and the lack of a biomedical construct for OA. OA arises in the primary care consultation in complex contexts of multi-morbidity, multiple and varied patient agendas which are often not explicit, and against a background of clinician agendas including time pressures, multiple guidelines and service commissioner requirements. Dissonance between doctors and patients was both observed and reported and was often underpinned by patient perception of lack of empathy and validation of their symptoms. Doctors and patients favour a ‘lay’ construct of OA where joint pain is seen as a normal part of life; this influences doctor and patient behaviour and acts as a significant barrier to formal recognition and hence treatment of the condition. Conclusion OA appears to be experiencing an identity crisis, with doctors and patients uncertain, (both consciously and subconsciously), of what constitutes OA and when to use the term ‘osteoarthritis’. Further work is needed to establish whether primary care should adopt a more biomedical construct of OA in order to bring OA more in line with other long term conditions such as cancer or heart disease, which have clearer clinical pathways. The need for public health messages regarding OA and optimal models of primary care for these patients also needs to be explored