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What is OA?
OA is the most common form of chronic arthritis and approximately 10% of men and 18% of women suffer symptomatic osteoarthritis1,2, 3. It is a degenerative disorder associated with loss of cartilage and remodelling of underlying bone4. Cartilage degradation usually occurs initially as a result of trauma, ageing or failure of joint repair and maintenance mechanisms1. Clinically, OA is characterised by chronic, progressive joint pain and stiffness after inactivity4,5. Although the aetiology of OA and the exact cause of pain are not completely understood, it is believed to be a complex response by the joints to biomechanical, genetic and environmental stresses6. OA increases in prevalence and also progresses with aging5.
What is the impact of OA?
Statistics show that in Australia, osteoarthritis is:
- The number one cause of persistent pain and disability in the community1,4 affecting at least 1.62 million Australians1.
- The 2nd most commonly reported chronic condition, after hypertension, in primary care7.
- The 7th most commonly managed condition in general practice8.
- The leading source of health expenditure on arthritis, accounting for $2.3 billion in 20071.
The need for improved care in OA
A recent report by Melbourne Health – Clinical Epidemiology and health service evaluation unit, claimed only one third of all OA patients receive the recommended care. In particular, they report inadequate documentation and management of pain in older OA patients and inadequate treatment in patients with multiple co-morbidities9.
In recognition of the substantial disability and economic impact, musculoskeletal diseases were designated a National Health Priority Area in 2002 with an additional $14.8 million dedicated for another four years in the 2006-2007 Federal Budget10.
Audit objectives
This clinical audit is designed to assist GPs in optimising analgesic therapy as part of an overall strategy to control pain and improve mobility, function and quality of life of patients with OA. The audit focuses on evidence-based pharmacological treatments for OA and patient safety. Surgical interventions, such as joint interventions, are beyond the scope of this audit.
The specific goals of the audit are to:
- Review existing management strategies for OA patients in-line with current literature2-5, 11-18
- Assess medical co-morbidities (e.g. gastrointestinal, cardiovascular, renal and hepatic function) before selecting appropriate analgesia for the relief of OA pain
- Assess dosing of paracetamol and its place in the treatment of OA
- Conduct a risk-benefit analysis of NSAID therapy
- Review use and dosage of tramadol in the management of OA
- Assess the use of opioids in the management of OA
- Evaluate adverse events with analgesics in patients with OA
- Identify potential drug-interactions with analgesics in patients with OA
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