Osteoarthritis is a common chronic disease in middle-aged and elderly people, which seriously affects their quality of life. Carrying out community-based management of osteoarthritis is conducive to the optimization of healthcare resource allocation and the improvement of the overall prevention and treatment level of osteoarthritis. However, current community-based management of osteoarthritis has many problems and is not effectively.
To perform a review and comparative analysis of the developments in foreign and domestic community-based management of osteoarthritis, and strategies addressing the existing problems, providing evidence for improving strategies regarding community-based management of osteoarthritis to improve the treatment and prognosis of osteoarthritis patients in China.
From October 2020 to January 2021, Studies related to osteoarthritis management in Chinese published from January 1, 2010 to January 1, 2020 were searched from databases of CNKI, Wanfang Data and CQVIP using "骨关节炎" plus "管理", "骨关节炎" plus "模式", "骨关节炎" plus "策略" as the search terms, and those in English published during the same period were searched from databases of PubMed, Web of Science, and the Cochrane Library using osteoarthritis and management, mode or strategy as the search terms. After excluding duplicates or those about self-management of osteoarthritis, the enrolled studies about community-based management of osteoarthritis were analyzed using systematic analysis.
Altogether, 2 695 studies were retrieved, 2 642 of them were excluded, and the other 53 were included. Five studies were about surveys on the management of osteoarthritis in the community, all of which revealed the lack of coordination and purpose in community-based management of osteoarthritis at home and abroad, and the key treatments are relieving symptoms, delaying cartilage degradation, and reducing the possibility of developing deformities, but the efficacies of such treatments were unsatisfactory, and symptoms often recurred. Moreover, community-based management modes of osteoarthritis in China were undiversified, mostly were various types of health education. Six studies proposed that the management of osteoarthritis in the community may be influenced by insufficient understanding of osteoarthritis in patients and their families, insufficient understanding and undervaluing of osteoarthritis in some primary care physicians, and uncoordinated healthcare resources, and put forward that a variety of factors led to the lack of coordination and purpose in the management of osteoarthritis in the community. There were three articles referring the significance of community-based osteoarthritis management, which highlighted that community-based osteoarthritis management could relieve pain, delay disease progression, and improve the quality of life in patients, and improve patients' satisfaction with treatment and services by healthcare professionals, as well as optimize the use of healthcare resources. There were 39 studies related to the strategies for community-based osteoarthritis management, 22 of which involved systematic management strategies, including 18 studies of multi-disciplinary or integrated management models and four studies of hierarchical management. As a whole, China's successful experience of managing diabetes and hypertension in the community has provided new ideas for the prevention and treatment of osteoarthritis, but most of the strategies were in the developmental stage, and their applications in practice needed further research. The remaining 17 studies involved various non-systematic community-based management strategies of osteoarthritis, including eight centering on health education, three focusing on internet-based management approaches, two involving telephone-based management, two focusing on non-drug management, and two focusing on written guidance.
There are problems in the community-based management strategies of osteoarthritis, including uncoordinated management, unsound methods, and imperfect systems. The referential community-based management strategies for osteoarthritis include: multidisciplinary or comprehensive management, hierarchical management and other systematic management strategies; making full use of medical techniques and tools (such as e-health, remote management, and health manuals) ; optimizing resource allocation (such as adding osteoarthritis management as a national essential public health project, and increasing government policy support for osteoarthritis management) .
Osteoarthritis is a chronic disease commonly seen in community settings, and the management of which is associated with numerous inter-related factors. Due to lack of appropriate healthcare-seeking perceptions and behaviors in osteoarthritis patients, it is difficult to diagnose, treat and manage osteoarthritis.
To understand healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients, providing evidence for improving the diagnosis and treatment of such patients in the community.
This was a mixed-methods study. From May to June 2019, interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors, as well as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners (GPs) from a general hospital in a regional healthcare consortium in Shanghai's Yangpu District, and a convenience sample of 12 GPs and 12 osteoarthritis patients from six community health centers (CHCs) in the same consortium. Then from June 2019 to December 2020, 425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews (excluding some highly subjective and less quantifiable indicators) for understanding their socio-demographic information, disease status, healthcare-seeking perceptions and behaviors, self-management and utilization of the APP for chronic disease management. Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis.
The following themes were extracted from the interviews: patients' insufficient awareness of osteoarthritis, lack of management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven of the 425 cases (93.4%) who effectively completed the questionnaire were included for quantitative analysis. One hundred and fifty-two (38.3%) respondents understood osteoarthritis, and 79 (52.0%) of them acquired relevant knowledge from the media, and other 50 (32.9%) from ward-mates. Two hundred (50.4%) respondents knew the treatments for osteoarthritis, including 91 (45.5%) knowing exercise and physical therapies, and 105 (52.5%) knowing treatment with painkillers. The healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex, BMI, pain level, impact of pain on sleep quality, and previous healthcare-seeking experience (P<0.05) . The results of regression analysis demonstrated that sex, BMI, pain level, previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking behavior (P<0.05) .
Community-living patients with osteoarthritis had insufficient awareness of healthcare-seeking and weak self-management awareness, and their healthcare-seeking behaviors were affected by multiple factors. To improve these patients' healthcare-seeking perceptions and behaviors, priority should be given to take actions to enhance patients' healthcare-seeking perceptions, train patients' self-management ability, better GPs' diagnostic and therapeutic skills, improve doctors and patients' negative attitude toward osteoarthritis treatment, and promote patients seeking healthcare actively.
Osteoarthritis has a high rate of disability and deformity, and can be combined with several physical and mental diseases. However, the early symptoms of the disease are not obvious. At present, there are problems in the management of osteoarthritis in the community such as uncoordinated management, inadequate methods and imperfect systems.
To construct and evaluate an informatics-based multidisciplinary management model for osteoarthritis patients in community, to promote the management of community osteoarthritis patients and improve the prognosis of the patients.
First a multidisciplinary management model of osteoarthritis patients in the community was constructed, including hierarchical management process of patients based on risk factor stratification, the multidisciplinary management team and its division of diagnosis and treatment, then an informatics based multidisciplinary management process was constructed, and information software development was completed. From July 2019 to July 2020, 80 patients with knee osteoarthritis who attended the general outpatient clinics of Dinghai and Daqiao Community Health Service Centers in Shanghai, and the orthopedics outpatient clinics of Yangpu District Central Hospital were randomly assigned into multidisciplinary management groups and general management group, with 40 patients in each group. The patients in general group were given conventional treatment, while the patients in multidisciplinary group were adopted information-based multidisciplinary management. Visual analogue scale (VAS) scores, Western Ontario McMaster University (WOMAC) osteoarthritis index score, the simplified scale of Arthritis Quality Of Life Measurement Scale (AIMS2) scores, Health Literacy Management Scale (HeLMS) scores, and body mass index (BMI) were assessed before and after 12 weeks of management, respectively.
Before treatment, there were no significant differences in VAS score, WOMAC osteoarthritis index score, AIMS2 score, Helms score, and BMI between patients with knee osteoarthritis in the multidisciplinary and general groups (P>0.05) . After 12 weeks of treatment, the VAS and WOMAC score of both the multidisciplinary and general groups went down, and the health literacy AIMS2 scores and Helms total score were higher after treatment than those before. The difference was statistically significant (P<0.05) . After 12 weeks of treatment, the AIMS2 total score and Helms total score of patients in the multidisciplinary group were higher than those in the general group, and the VAS score, WOMAC osteoarthritis index, and BMI were lower than those in the general group, with significant differences (P<0.05) .
The implementation of an informatics based community multidisciplinary management model for patients with osteoarthritis of the knee can effectively reduce the patients' joint pain and control their weight, improve their ability of daily living and health literacy, improve the quality of life of patients, and delay the progress of the disease.
