From: Developing a model osteoarthritis consultation: a Delphi consensus exercise
Statement | No. (%) GP group would include (n = 15) | No. (%) Patient group would include (n = 14) |
---|---|---|
The GP:* | ||
Assesses the degree of pain using a formal measure, such as rating the pain on a scale from 0 to 10 | 1 (7) | 8 (57) |
Assesses the extent of mobility problems using a formal measure, such as a rating scale from 0 to 10. | 1 (7) | 7 (50) |
Asks about a family history of joint problems | 6 (43) | 4 (29) |
Asks about jobs which may have affected/caused the knee problem, such as those involving a lot of kneeling (for example, carpet fitter, cleaner, joiner, electrician) | 9 (64) | 5 (36) |
Asks about the patient’s expectations of the consultation | 10 (67) | 4 (31) |
Asks which problem, concerning the knee, the patient wants help with most, for example pain, stiffness or climbing the stairs | 9 (60) | 5 (38) |
Asks about who the patient has seen, or asked for help from, about the problem | 10 (71) | 6 (46) |
Assesses the patient’s mood for symptoms of anxiety and depression | 8 (53) | 1 (8) |
Screens the patient for depression using a formal depression screening tool | 0 (0) | 0 (0) |
Asks about other conditions, such as diabetes, heart or kidney disease, which might affect the management of the knee problem | 10 (67) | 9 (64) |
Asks about circumstances, such as unemployment and financial hardship, which might affect the management of the knee problem | 5 (33) | 0 (0) |
Assesses the knee joint by general observation of the patient’s walking pattern, mobility and footwear | 13 (87) | 9 (69) |
Performs a specific test, such as a timed walk test, to assess function | 0 (0) | 3 (21) |
Examines the other knee, hips and hands for signs of osteoarthritis | 11 (73) | 10 (71) |
If not recently done, measures weight and height to calculate the body mass index | 6 (40) | 6 (46) |
Undertakes a full examination of the locomotor system (of the joints and muscles) | 0 (0) | 4 (33) |
Enquires about the patient’s views and understanding of osteoarthritis | 13 (87) | 9 (75) |
In addition to giving a brief explanation explains the likely cause of osteoarthritis | 4 (27) | 9 (69) |
In addition to giving a brief explanation explains the likely outcome for people with osteoarthritis | 9 (60) | 8 (62) |
Explores the patient’s understanding of the information given, and their reaction/beliefs/feelings about it | 8 (53) | 8 (62) |
Tells the patient that they are central to the management of their own condition: that self-management of osteoarthritis is necessary and important | 13 (87) | 11 (85) |
Explains that the central role of the primary healthcare team in the management of osteoarthritis is to support and guide self-management | 7 (47) | 9 (69) |
Explains the purpose of managing osteoarthritis to: improve understanding, reduce pain, improve mobility and reduce the risk of it getting worse | 9 (60) | 12 (86) |
Explains the approach to the treatment of osteoarthritis recommended by NICE | 3 (20) | 8 (62) |
In addition to handing out the guidebook highlights sections in the guidebook relevant to the patient’s problem | 6 (40) | 6 (46) |
Asks if the patient has any views/preferences for what treatment they might want to consider next, and, if they do, what they are | 12 (80) | 6 (43) |
Takes an “exercise history”: the patient’s attitude to taking exercise/physical activity/exercises and their experience of these | 9 (60) | 6 (43) |
Takes a “weight history”: the patient’s attitude to losing weight and their prior experience of doing this | 7 (47) | 9 (69) |
Indicates, if the patient is overweight, where they are on a body mass index chart | 7 (47) | 9 (69) |
Explains that exercise may cause muscle soreness initially and that the benefits of exercise may not be immediate | 9 (60) | 5 (38) |
Explains the risks and benefits of painkillers | 11 (73) | 6 (50) |
Discusses with the patient whether any other extra treatment needs to be considered | 7 (47) | 8 (67) |
Discusses appropriate referrals, for example to; physiotherapy, occupational therapy, podiatry, social services, community pharmacy, district nursing service or work support services | 8 (53) | 10 (71) |
Discusses the option of joint replacement surgery in patients with established severe pain, or severe functional limitation, in addition to core treatments and painkillers | 7 (47) | 7 (54) |
Formulates with the patient a self-management plan | 11 (73) | 10 (77) |
Explains when the patient should re-consult the GP | 11 (73) | 8 (57) |