Primary Care Provider Educational Tool to Improve Osteoarthritis Management in the Primary Care Setting

Objectives Osteoarthritis is the most common form of arthritis, and its prevalence is increasing. As a non-inflammatory type of arthritis, it can be managed in the primary care setting with nonsteroid anti-inflammatory drugs, physical and occupational therapy, self-efficacy programs, and orthopedic referral for injections or surgery. At the University of Vermont Health Network, only 1 in 4 patients seen for joint pain have inflammatory arthritis,[1] and our wait time for new patients is 9 months. To address unnecessary referrals to rheumatology, we developed and evaluated an educational tool for differentiating non-inflammatory arthritis from inflammatory arthritis to improve provider comfort with managing osteoarthritis.

Methods We conducted a chart review of adult patients diagnosed with osteoarthritis (n=390) at the University of Vermont Medical Center rheumatology clinic between 2020 and 2022 to gather data on referral patterns and outcomes. We used a pilot survey to assess primary care provider baseline comfort with diagnosing and treating osteoarthritis, which informed the creation of a two-page educational tool. The tool was introduced with a brief education session to primary care providers at 27 of 28 clinics in the network. The utility and impact of the tool was assessed with pre- (n=94) and post-intervention (n=32) surveys at 2 months.

Results Osteoarthritis was diagnosed at the first visit in 390 patients referred to rheumatology for joint pain, accounting for 9% of all new patient referrals. Only 5% of these patients were seen again in rheumatology clinic and only 3% were found to have an inflammatory disease as a primary or concurrent diagnosis. Prior to the introduction of the tool, clinicians were least comfortable with knowing when to refer to rheumatology and most comfortable with diagnosing osteoarthritis. Post-intervention survey data indicated improvement in overall comfort with managing osteoarthritis (8% improvement, p=0.04) and knowing when to refer to orthopedics (10%, p=0.04). Half of clinicians (50%) reported using the tool in their practice, 63% described value in using the tool in medical education, and 43% in shared decision making. After using the tool, 34% anticipate a reduction in referrals to rheumatology and 9% have already referred fewer patients to rheumatology.

Conclusion We developed and distributed an educational tool to primary care providers. Pre- and post-intervention surveys indicate that this was an effective approach for improving PCP comfort in the diagnosis and management of non-inflammatory joint pain with anticipation of fewer referrals to rheumatology resulting in improved access to care. [1.] Thoms BL. Rheumatol Adv Pract 2023;7(3):rkad067.