A new decision tree for diagnosis of osteoarthritis in primary care: international consensus of experts.

BACKGROUND AND AIMS: Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. METHODS: To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA. The IRB used American College of Rheumatology diagnostic criteria. RESULTS: Care pathways based on clinical and radiological findings were developed to identify intervention thresholds for GPs/specialists. To optimize usefulness in the primary care setting, the guidelines were formatted as an uncomplicated, but comprehensive one-page decision tree for each topology, highlighting key aspects of the evaluation process and incorporating red flags. In a two-phase validation stage, the draft guidelines were evaluated by rheumatologists and GPs for project execution, content and perceived benefit. The strength of the guidelines lies in their user-friendly diagram and potential for broad application. Such guidelines will allow GPs to make an easy but definite diagnosis of OA and offer clear guidance about situations requiring an expert opinion. The guidelines have potential to improve patient outcomes and reduce the number of unnecessary procedures. DISCUSSION AND CONCLUSIONS: This project demonstrated the feasibility of developing easy-to-use and effective visual decision trees to facilitate the diagnosis and management of OA of the hip, knee and hand/finger in primary care. The next step should be to conduct a large impact study of implementation of these recommendations in the diagnostic management of OA in general practice in different areas.

[Attitudes and opinions of private practitioners towards alcoholism. A survey in the Languedoc-Roussillon region]. / Attitudes et opinions des médecins libéraux sur l'alcoolisme. Une enquête en région Languedoc-Roussillon.

OBJECTIVE: Information on the position of private practitioners faced with the problem of alcoholism mainly concerns the role of the general practitioner in the follow-up of these patients and there is little information from private specialists, hence the need for new data METHOD: All the general practitioners and specialists in the Languedoc-Roussillon area were interviewed through a mailed questionnaire regarding their opinion on alcohol consumption and public health; their definition of the risks; moderate consumption and health; how they approached the question of drinking during consultations and their involvement in training and prevention. RESULTS: Six hundred sixty-five practitioners (12.4% of those interviewed) returned the questionnaire. The profile of those who replied was identical to that of the whole population surveyed. The medical corps is clearly aware of the need to fight against alcohol abuse, but this is associated with a relative ignorance of the basics of alcoholism, a non-systematic approach of the question of drinking during consultations, little involvement in its management, limited use of the specialised structures and limited training on the question. The specialists are less involved than the general practitioners, but appear more at ease when approaching the question of drinking with their patients and resort more frequently to specialised structures than the general practitioners. Continued medical training on alcoholism only concerned a minority of practitioners and its practical impact was low. CONCLUSION: With regard to alcoholism, the practitioners fulfill their role in providing medical care, within the limits of available therapeutic resources, but their role with regard to the reduction of the risks, i.e., primary or early prevention is more or less disregarded.