What Patients Do Following a New Diagnosis of Knee Osteoarthritis
Authors: Grindrod K.A. , Marra C.A. , Colley L. , Oteng B. , Gastonguay L. , Tsuyuki R.T. 
Published: January 2009

Objective

To describe patient use of health services and products within 6 months of a new diagnosis of knee OA.

Methods

Patients with knee pain and no previous diagnosis of knee OA were recruited by community pharmacists using a simple questionnaire to determine the likelihood of knee OA. In total, 194 participants considered likely to have knee OA were referred to a rheumatologist for a standardized knee exam and radiograph. Of these, 190 were confirmed to have knee OA and were subsequently followed for a period of 6 months. At baseline, 1, 3 and 6 months, a survey was administered that contained questions designed to elicit information on participants' health service and product use. Categories included pain-relieving medication, exercise (e.g., walking), treatments/aids (e.g., knee taping/brace, acupuncture, Arthritis Society Management Program, shoe inserts) and supplements (e.g., glucosamine). In addition, to assess participant satisfaction with pharmacy services, participants were asked to rate their levels of agreement with 4 statements using a five-point Likert scale.

Results

Follow-up data for all 3 time points were available for 124 (65%) participants. Of these, 64% were female, the mean age was 63 years and 67% were considered either obese or overweight according to their body mass index (BMI). By 6 months, 93% had visited their primary care practitioner for OA, 74% had initiated exercise, 59% had started supplements, 51% had taken pain-relieving medications and 45% had used activity aids. When asked “who gave you this advice,” the majority of participants stated “on my own” for all categories. This was followed by “family physician” for all categories except supplements, which were recommended by “family/friend” 20% of the time. Participants selected “pharmacist” least frequently in all categories, including for the initiation of pain-relieving medication, where only 2% reported a pharmacist recommendation. Of those taking pain-relieving medications, 49% took NSAIDs, 28% took acetaminophen and 12% took a combination of both. The majority of participants were very satisfied with the pharmacy services received (>90%) and few reported any complaints (>10%). While 18% of participants thought that pharmacy services could be better, only 17% thought that pharmacy services were just about perfect.

Conclusion

Following a diagnosis of knee OA, the majority of participants sought out an intervention, the most popular being exercise and natural medicine supplements. Despite the initial diagnosis by a pharmacist and self-reported satisfaction with pharmacy services, few participants attributed interventions to pharmacists. Even with recent evidence showing that pharmacist involvement can reduce potentially dangerous NSAIDs use in knee OA, most participants appeared to make lifestyle changes independent of health professional advice, and pharmacists played a very small role in this. These results suggest that more work is needed to expand the role of pharmacists toward chronic disease management.