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Wie leitliniengerecht ist die Behandlung degenerativer Gelenkerkrankungen in der hausärztlichen Praxis?

Ein Vergleich internationaler Leitlinien mit selbst berichtetem Vorgehen

The management of osteoarthritis by general practitioners in Germany

Comparison of self-reported behaviour with international guidelines

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Abstract

Hintergrund

Für Arthrosepatienten ist der Hausarzt primärer Ansprechpartner und „Lotse“ im Gesundheitssystem. Eine deutsche Leitlinie für den hausärztlichen Sektor existiert bislang nicht. Ziel der vorliegenden Arbeit war es, das hausärztliche Vorgehen bezüglich Diagnostik, Therapie und Überweisungen an Orthopäden zu untersuchen.

Methoden

Es handelt sich um eine Querschnittsstudie mittels eines selbst erstellten, strukturierten Fragebogens mit einer Stichprobe von 144 Hausärzten.

Ergebnisse

In der Diagnostik wurde die Bedeutung der Bildgebung überschätzt. Die Bewertung der therapeutischen Optionen stimmte mit den vorhandenen internationalen Leitlinien weitgehend überein, wobei die Präferenz auf nicht-invasiven Verfahren mit z. T. mangelnder Evidenz lag. In der medikamentösen Therapie wurden nicht-steroidale Antirheumatika (NSAR) den COX-2-Inhibitoren vorgezogen. Eine ambivalente Haltung bestand gegenüber der Weiterverweisung zu Orthopäden.

Schlussfolgerung

Eine hausärztliche Leitlinie mit der Betonung spezifisch hausärztlicher Aspekte könnte die Effizienz in Diagnostik und Therapie verbessern und das hausärztliche Aufgabengebiet bei Arthrosepatienten klarer abgrenzen.

Abstract

Background

In most countries, guidelines for the treatment of osteoarthritis (OA) are available. However, in Germany, no guideline for the primary care sector is available. The care provider of most patients is the general practitioner (GP). The aim of the study was to investigate the approaches in diagnosing and treating OA of German GPs and to assess adherence to international guidelines.

Methods

Cross-sectional study using a structured questionnaire with a random sample of 144 GPs.

Results

Regarding diagnosis, the importance of X-rays was overestimated. Regarding treatment approaches, exercising and weight reduction were regarded as primary treatment targets. Pharmacological treatment approaches were somewhat guideline oriented, but conservative approaches such as physical therapy were overestimated as invasive treatments such as intra-articular injections were underestimated in its benefit.

Conclusion

Establishing a guideline specifically for primary care and increasing guideline adherence could help to prevent the present overuse of X-rays and the high amount of referrals to orthopaedics, save costs and reduce inadequate treatments.

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Danksagung

Das Projekt wurde vom Bundesministerium für Bildung und Forschung (BMBF) finanziert, Fördernummer 01GK0301. Die Autoren danken allen teilnehmenden Ärzten.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Voßstraße 2, 69115, Heidelberg, Deutschland

    T. Rosemann, S. Joos & J. Szecsenyi

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  1. T. Rosemann
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  2. S. Joos
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  3. J. Szecsenyi
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Correspondence to T. Rosemann.

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Rosemann, T., Joos, S. & Szecsenyi, J. Wie leitliniengerecht ist die Behandlung degenerativer Gelenkerkrankungen in der hausärztlichen Praxis?. Orthopäde 37, 69–74 (2008). https://doi.org/10.1007/s00132-007-1175-3

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