74. Uptake of the Nice Osteoarthritis Core Treatments In Community Dwelling Older Adults with a Self-Reported Primary Care Consultation for Joint Pain

Abstract

Background: The National Institute for Health and Care Excellence OA guidelines (2008) recommend that patients with OA should be offered specific treatments in primary care. The aim of this study was to compare uptake of core non-pharmacological treatments (education and access to information, advice on muscle strengthening exercise and general aerobic fitness and, if appropriate, advice on losing weight); paracetamol and topical non-steroidal anti-inflammatory drugs (NSAIDs) in community dwelling older adults with a self-reported primary care consultation for joint pain. Methods: A cross-sectional population survey was mailed to adults aged 45 years and over (n=28,443) registered with 8 general practices in North West Midlands as part of the MOSAICS study. Participants provided information on the presence of joint pain (knee, hip, foot, hand), consultation behaviours and management of their joint pain over the last 12 months. Uptake of recommended treatments was (Table presented) compared between consulters with joint pain and those with a formal diagnosis of OA as identified from medical records. Results: Of 15,083/28,443 (53%) respondents, mean age was 63.9 years (11.2sd); 54% were female. 11,928 respondents (79%) reported joint pain in the target sites of which 4,777 (40%) reported consulting primary care; 465 (3.9%) had been given an OA diagnosis. Pharmacological treatments were more frequently used than nonpharmacological treatments (Table 1). Those with an OA, rather than joint pain, code were significantly more likely to receive written information, muscle strengthening exercise and topical NSAIDS. In adults aged 65 years and over (compared with those 45-64 years) paracetamol was significantly more likely to be used (P=0.01). Core non-pharmacological treatments of education and access to information (P=0.01) and exercise (P<0.001) were significantly less likely to be used in those over 65 when compared with the younger age groups. Conclusion: The self-reported uptake of core non-pharmacological treatment was found to be lower than use of paracetamol and topical NSAIDs in adults 45 years and over consulting with joint pain. There is a clear shift from recommending the non-pharmacological treatments to the pharmacological treatments with increasing age, in contrast to NICE guidance recommending treatments irrespective of age.