Quality of care for hip and knee osteoarthritis at family medicine clinics: Lessons from Mexico

Abstract

Objective: (i) To develop quality-of-care indicators suitable for evaluation of care for knee and hip osteoarthritis (KHOA) at the primary care level using data from the electronic health records (EHRs) and (ii) to evaluate the quality of care that patients with KHOA receive at family medicine clinics (FMCs). Design: (i) Development of indicators following the RAND-UCLA method. (ii) A cross-sectional analysis of quality-of-care provided for patients with osteoarthritis. Setting: Four FMCs in Mexico City. Participants: Knee and hip osteoarthritis patients, older than 19 years. Source of the Information: 2009 EHR data. Main Outcome Measure(s): Quality of care was evaluated using six indicators developed in the first stage of this study. Results: The quality of care evaluation identified that 26.1% of patients were advised in regard to physical exercise, and weight loss was encouraged in 19.7%. Only 5% of patients received acetaminophen as an initial oral analgesic; 54% of patients at risk for gastrointestinal complications received gastroprotective medicines. On average, the percentage of recommended care received was lower for patients who attended only one visit with family physician (17.6%) and higher for those with >3 visits (41.9%). Conclusion: The quality of osteoarthritis care at FMCs in Mexico is suboptimal relative to the standards of care and requires continuous evaluation and implementation of improvement strategies.