Use of Standardized Guidelines for Non-Surgical Management of Knee and Hip Osteoarthritis

Background: Osteoarthritis is a debilitating condition that is increasing in prevalence in the general adult population worldwide. Although established clinical guidelines exist, there are multiple barriers to guideline implementation. Osteoarthritis and its related costs also have a significant impact on the United States Military. The rate of osteoarthritis in service members is 26% higher than the general population for ages 20-24 and nearly twice as high for service members age 40 and older. Purpose: To identify potential barriers to the use of established clinical practice guidelines for non-surgical management of knee and hip osteoarthritis and implement a process to facilitate increased use of these guidelines in the military health care system. Methods: The setting for this project was the family medicine clinic at a large Unites States Military treatment facility serving both active duty and civilian patients. A pre-survey was sent to providers assessing knowledge of guidelines and potential barriers to use, followed by an educational in-service presenting the guidelines and discussing their use. Providers were asked to use the guidelines for their patients with knee or hip osteoarthritis. Two weeks later, a post-survey was sent to providers to assess guideline use rates and whether providers found the presentation of guidelines and information helpful. Results: The top three barriers identified were time constraints, lack of training in intraarticular injections, and difficulty obtaining physical therapy referral. Most respondents indicated knowledge of the guidelines, but half reported using the guidelines less than 50% of the time. Conclusion: Both system and provider level barriers to guideline use were identified. Despite a small sample size and short study timeframe, results may help facilitate greater use of established practice guidelines. Future work should differentiate between military and civilian providers.