Understanding the Primary Care Osteoarthritis Consultation using Video-Stimulated Recall

Background: Osteoarthritis (OA) is the commonest long term condition in primary care. Current guidance suggests that much can be done to improve outcomes but existing research suggests doctors and patients are pessimistic about OA treatment. An important question concerns the role of the primary care consultation in this incongruity. This study used a combination of video recorded consultations and post consultation interviews using video-stimulated recall (VSR), to uncover what happens when patients discuss OA with their general practitioners (GPs).Methods: With ethical approval, GP consultations with 190 consenting patients aged = 45 were recorded. Twenty consultations contained reference to OA, and 17 of these patients and their GPs (n=13) participated in post consultation interviews. Analysis involved thematic analysis of videotapes and comparisons of patient and GP interviews with the consultation findings.Results: Osteoarthritis arises in the 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 requirements. Dissonance between doctors and patients was observed and was often underpinned by patient perception of lack of empathy and symptom validation. Doctors and patients often adopt 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.Conclusions: The design of interventions to improve outcomes of patients with OA must take account of the complexity and heterogeneity of presentations in primary care. Osteoarthritis appears to be experiencing an identity crisis, with doctors and patients uncertain of what constitutes OA and when to use the term ‘osteoarthritis’. Further work is needed to identify effective ways of translating best evidence about OA management into effective primary care strategies