Inequalities in morbidity and consulting behaviour for socially vulnerable groups.

BACKGROUND: The focus of health policy on improving health and reducing inequality for socially vulnerable groups. AIM: To examine self-report of condition-specific morbidity and consultation with the general practitioner (GP) for socially vulnerable groups. DESIGN OF STUDY: Cross-sectional survey using a modified version of the General Practitioner Assessment Survey (GPAS). SETTING: Ten general practices in each of six health authorities. METHOD: A random sample of 200 patients was selected from each practice. The questionnaire elicited information about experience of specific acute and chronic conditions and whether the GP had been consulted. Four sub-samples were selected from the 4493 registered patients who responded to the self-completion questionnaire. They were lone mothers (n = 160), elderly living alone (n = 417), the unemployed (n = 100), and members of ethnic minority groups (n = 316). RESULTS: Logistic regression analyses showed that, after adjustment for age, sex, smoking, and housing tenure, only lone motherhood and ethnic minority group status were consistently and independently associated with poorer health outcomes. Lone motherhood was associated with a higher likelihood of anxiety (odds ratio [OR] = 2.03, 95% confidence interval [CI] = 1.34 to 3.08) and sleep problems (OR = 1.83, 95% CI = 1.18 to 2.83) and ethnic minority group status with a higher likelihood of depression (OR = 2.02, 95% CI = 1.34 to 3.04), diabetes (OR = 4.03, 95% CI = 2.54 to 6.39, migraine (OR = 1.72, 95% CI = 1.26 to 2.35), and minor respiratory symptoms (OR = 1.75, 95% CI = 1.33 to 2.29). Ethnic minority group status was the only source of social vulnerability that was independently associated with a higher likelihood of GP consultation, particularly for episodes of illness such as backache (OR = 3.28, 95% CI = 2.06 to 5.21), indigestion (OR = 2.94, 95% CI = 1.53 to 5.65), migraine (OR = 3.22, 95% CI = 1.75 to 5.93), minor respiratory symptoms (OR = 3.53, 95% CI = 2.26 to 5.50) and sleep problems (OR = 4.72, 95% CI = 2.56 to 8.71). CONCLUSIONS: Social vulnerability can be a risk factor for poorer health, but this is dependent on the source of vulnerability and is condition-specific. No association was found between inequity in the utilisation of primary care and social vulnerability. The propensity for members of ethnic minority groups to consult more than white people, particularly for acute conditions, requires further exploration.     

Population survey comparing older adults with hip versus knee pain in primary care

BACKGROUND: Knee pain is nearly twice as prevalent as hip pain in elderly people, yet knee replacement is far less common than hip replacement. AIM: To investigate whether systematic differences in the primary care management of hip versus knee problems might explain the disparate rates of joint replacement. DESIGN OF STUDY: Cross-sectional, population-based postal survey. SETTING: Random sample of 5500 Oxfordshire residents aged 65 years and above. METHOD: Screening questions were used to identify symptomatic individuals: "During the past 12 months, have you had pain in or around either of your hips/knees on most days for 1 month or longer?". Standard (Lequesne) severity ratings were obtained for each hip and knee. Logistic regression was used to estimate odds ratios (ORs) for "knee cases" versus "hip cases" for selected healthcare services and attitudes toward replacement. RESULTS: Among 3341 responders, 212 hip cases and 612 knee cases were identified. Knee pain led to a GP consultation more often than hip pain (OR = 1.76, P = 0.04), but specialist referral was no more likely (OR = 0.85, P = 0.57). Similar percentages of hip and knee cases would agree to hip/knee replacement surgery if it was offered, but hip and knee cases differed in their views on the general success of joint replacement. CONCLUSIONS: Some variations in primary care management for hip versus knee pain were apparent. People with hip pain were mostly positive about replacement outcomes, whereas people with knee pain were more uncertain about replacement. Attitudes appeared to be influenced by knowing someone who had undergone such surgery.     

Psychomotor retardation in elderly depressed patients

BACKGROUND: Up to 70% of older people who commit suicide consult a general practitioner (GP) in the month prior to their death. The purpose of this study was to identify the clinical and demographic characteristics of older adults who are contemplating suicide and are in contact with a GP. METHODS: We utilised a cross-sectional study to investigate the association between suicidal ideation and clinical/demographic variables of 504 consecutive patients aged 60 years or over, attending 1 of 54 randomly selected Western Australian GPs. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about suicidal ideation (Depressive Symptom Inventory-Suicidality Subscale, DSI-SS), demographic factors, lifestyle factors, physical health and mental health, including depression (Center for Epidemiologic Studies-Depression Scale, CES-D). RESULTS: Within our sample of older patients, 6.3% acknowledged current suicidal ideation. Multivariate analyses indicated that current suicidal ideation was strongly associated with being depressed at least occasionally during the previous week (OR=7.3, 95% CI=2.3-23.0), CES-D scores of 16 points or greater (OR=3.6, 95% CI=1.0-12.1), and a prior history of attempted suicide (OR=15.5, 95% CI=4.0-60.6). Limitations: Our results and conclusions are limited to suicidal ideation, and may not apply to suicidal behaviour. CONCLUSIONS: Depressive symptomatology is strongly associated with suicidal ideation in later life. Strategies that enhance GPs' identification and treatment of affective illness in older patients should have the greatest impact on suicide rates within this age group.     

Why women consult with increased vaginal bleeding: a case-control study.

BACKGROUND: Many women with heavy periods and irregular bleeding do not consult about them. It has been suggested that some of these symptoms are associated with psychological distress and that this influences consultation behaviour which may account for why some women present with a menstrual disturbance and others with apparently the same problem do not. AIM: To explore the relationship between symptom severity, psychological distress, and the seeking of medical help in primary care among women aged 54 years or less with increased vaginal bleeding. DESIGN OF STUDY: Case control. SETTING: An urban four-partner general practice of 10,000 patients. METHOD: Questionnaires were sent to women who were consulting with new episodes of 'increased vaginal bleeding' and two groups of controls: consulting controls with 'acute respiratory tract infection' (RTI) or 'other illness' as identified by weekly computerised searches, and community controls, selected from the practice age-sex register. RESULTS: Nine hundred and forty-three questionnaires were sent out to 108 cases and 835 controls with an 80% response rate. Of these, 60.9% of the cases, 47.0% of the consulting controls, and 39.7% of the community controls were subjects with probable psychological distress on the General Health Questionnaire (chi2 test, P = 0.002). Cases were more likely than community controls to have heavy periods (odds ratio [OR] = 2.86, 95% confidence interval [CI] = 1.53-5.35) and heavy periods interfering with life (OR = 3.69, 95% CI = 2.02-6.75). After controlling for heaviness of periods, cases were still more likely to have psychological distress (OR = 1.80, 95% CI = 1.00-3.24). The same relationships prevailed when comparing cases and consulting controls. CONCLUSION: Interference in life caused by heaviness of periods appears to be a powerful initiator of consultation with increased vaginal bleeding. Perceived heavy periods and psychological disturbance are weaker predictors. Women presenting to primary care with increased vaginal bleeding are more likey to have a psychological disturbance than women from the community or those consulting with another illness.     

Predicting colorectal cancer risk in patients with rectal bleeding

BACKGROUND: Rectal bleeding is an important symptom of colorectal cancer but has low predictive value in primary care. AIM: To determine which characteristics of rectal bleeding, along with other factors, are predictive of colorectal cancer. DESIGN OF STUDY: Observation study of patients with rectal bleeding referred to an open-access diagnostic clinic. SETTING: Primary care, southern England. METHOD: Symptom data were collected, using a self-completed questionnaire. Logistic regression techniques were used to determine predictors of colorectal cancer. RESULTS: There were 604 patients in the study and 22 (3.6%, 95% confidence interval [CI] = 2.0% to 5.2%) were diagnosed with colorectal cancer. Significant predictors of colorectal cancer were found to be age (<50 years: odds ratio [OR] = 1; 50-69 years: OR = 5.1, 95% CI = 1.4 to 18.6; > or = 70 years: OR = 8.2, 95% CI = 2.1 to 31.8) and blood mixed with the stool (Likelihood ratio [LR] 1.5; adjusted OR = 3.8; 95% CI = 1.4 to 10.5). Presence of haemorrhoids associated with bright red bleeding not mixed with stool reduced the likelihood of cancer (OR = 0.4, 95% CI = 0.1 to 1.2) but did not eliminate it--a cancer was present in 2% of patients with these symptoms. CONCLUSION: Patient-reported type of rectal bleeding as an isolated symptom has insufficient diagnostic value to be useful in general practice. By studying referred patients, we may even have overestimated its value. At best, it could be useful as a component of a composite symptom score to guide referral decisions.     

Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study

We prospectively assessed the 1-month prevalence of abnormal body fat distribution in HIV-infected individuals. Of 1,359 patients treated with antiretroviral drugs, 578 (43%) had signs of abnormal fat distribution. Peripheral fat loss was observed in 382 patients (28%), whereas 412 (30%) had signs of fat accumulation. The presence of lipodystrophy (peripheral fat loss with or without fat accumulation) was found to be independently associated with increasing age (less than 35 years of age as a reference group: 35 to 41 years of age, OR = 1.5 [95% CI, 1.1-2.3]; and older than 41 years of age, OR = 2.4 [95% CI, 1.7-3.5]), current use of stavudine (OR = 2.4 [95% CI, 1.8-3.3]), current use of abacavir (OR = 2.1 [95% CI, 1.3-3.4]), and elevated lactate level (OR = 1.6 [95% CI, 1.1-2.4]). The prevalence of lipodystrophy was higher among patients who had received stavudine for a longer period (no stavudine in the current combination as a reference group: <6 months, OR = 1.1 [95% CI, 0.6-1.8]; 6-24 months, OR = 2.4 [95% CI, 1.7-3.5]; and >24 months, OR = 3.2 [95% CI, 2.4-4.3]). This study confirms the association between the use of stavudine and lipodystrophy.     

Patients evaluate accessibility and nurse telephone consultations in out-of-hours GP care: determinants of a negative evaluation

OBJECTIVE: The shift towards large-scale organization of out-of-hours primary healthcare in different western countries has created an important role for the nurse telephone consultation. We explored the association between negative patient evaluation of nurse telephone consultations and characteristics of patients and GP cooperatives. METHODS: A cross-sectional study using postal patient questionnaires sent to patients receiving a nurse telephone consultation from one of 26 GP cooperatives in the Netherlands. RESULTS: The total response was 49.3% (2583/5239). Negative evaluations were most frequently encountered for the general information received on the GP cooperative (35%). When patients expected a centre consultation or home visit, but only received a nurse telephone consultation, they were more negative about the accessibility (OR 1.7, CI 1.4-2.1) and nurse telephone consultation (OR 4.2, CI 3.2-5.6). In the presence of a special supervising telephone doctor at the cooperative's call centre, nurse telephone consultation was evaluated significantly less negative (OR 0.4, CI 0.2-0.8). CONCLUSION: Expectation of care mode was most strongly associated with a negative evaluation of nurse telephone consultation. The presence of a supervising telephone doctor may lead to a better evaluation of nurse telephone consultations. PRACTICE IMPLICATIONS: More attention should be paid to the provision of patient information on the GP cooperative and discrepancies between the care expected and the care offered.     

Does psychological status predict the presentation in primary care of women with a menstrual disturbance?

Thirty per cent of women aged 35 years and over suffer from heavy menstruation, but only 7% have consulted a doctor in the previous six months, suggesting that a significant number of these women do not consult a general practitioner. There is evidence that women who report heavy menstruation are more likely to have symptoms of psychological disturbance. This study sets out to determine whether the presence of symptoms of anxiety and depression might be linked to subsequent consultation for increased vaginal bleeding in primary care.     

Detecting suicidal ideation in older patients: identifying risk factors within the general practice setting

BACKGROUND: GPs are the most frequently accessed health professional among suicidal individuals in the community.AIM: To determine the prevalence of psychological distress and suicidal ideation among patients aged 60 years and older presenting to GPs, and the relationship between these variables in detecting patients who may be contemplating suicide.Design of study: Cross-sectional analysis of older patients presenting to Australian GPs between 2002 and 2003. SETTING: One thousand and sixty-one consecutive patients aged 60 years or over attending one of 54 randomly selected Western Australian GPs. METHOD: Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about current suicidal ideation (Depressive Symptom Inventory Suicidality Subscale [DSI-SS]) and depression (Center for Epidemiological Studies Depression Scale [CES-D]). Patients' chief complaints were obtained from consultation summary sheets completed by their GP. RESULTS: Although only 5.1% of patients presented with psychological complaints, 5.8% acknowledged current suicidal ideation and 23.8% had clinically significant levels of depressive symptomatology. Suicidal ideation was associated with CES-D scores greater than 16 (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.5 to 8.9), feelings of depression (OR = 7.7, 95% CI = 3.4 to 17.7), and previous suicide attempt (OR = 7.4, 95% CI = 2.7 to 20.2) in a logistic regression model, but not with poor self-perceived health, use of licit drugs (smoking, alcohol, and hypnotics), or type of presenting complaint at the time of assessment. CONCLUSIONS: Although older general practice patients tend to present for issues related to their physical health, approximately a quarter of this cohort also possess high levels of psychological distress, including current thoughts of suicide. Older patients who show any signs of depression or distress should be asked about psychological symptoms, including suicidal ideation.     

Accuracy of symptoms and signs for coronary heart disease assessed in primary care

Background

Diagnosing the aetiology of chest pain is challenging. There is still a lack of data on the diagnostic accuracy of signs and symptoms for acute coronary events in low-prevalence settings.

Aim

To evaluate the diagnostic accuracy of symptoms and signs in patients presenting to general practice with chest pain.

Design of study

Cross-sectional diagnostic study with delayed-type reference standard.

Setting

Seventy-four general practices in Germany.

Method

The study included 1249 consecutive patients presenting with chest pain. Data were reviewed by an independent reference panel, with coronary heart disease (CHD) and an indication for urgent hospital admission as reference conditions. Main outcome measures were sensitivity, specificity, likelihood ratio, predictive value, and odds ratio (OR) for non-trauma patients with a reference diagnosis.

Results

Several signs and symptoms showed strong associations with CHD, including known vascular disease (OR = 5.13; 95% confidence interval [CI] = 2.83 to 9.30), pain worse on exercise (OR = 4.27; 95% CI = 2.31 to 7.88), patient assumes cardiac origin of pain (OR = 3.20; 95% CI = 1.53 to 6.60), cough present (OR = 0.08; 95% CI = 0.01 to 0.77), and pain reproducible on palpation (OR = 0.27; 95% CI = 0.13 to 0.56). For urgent hospital admission, effective criteria included pain radiating to the left arm (OR = 8.81; 95% CI = 2.58 to 30.05), known clinical vascular disease (OR = 7.50; 95% CI = 2.88 to 19.55), home visit requested (OR = 7.31; 95% CI = 2.27 to 23.57), and known heart failure (OR = 3.53; 95% CI = 1.14 to 10.96).

Conclusion

Although individual criteria were only moderately effective, in combination they can help to decide about further management of patients with chest pain in primary care.     

Predicting the duration of symptoms in lower respiratory tract infection.

BACKGROUND: Acute lower respiratory tract infection (LRTI) presenting in primary care has a long natural history. Antibiotic treatment makes little or no difference to the duration of cough. Limited information is currently available regarding predictors of illness duration. AIM: To determine predictors of illness duration in acute LRTI in primary care. DESIGN OF STUDY: Secondary analysis of trial data to identify independent predictors of illness severity and duration. SETTING: Primary care. METHOD: Eight-hundred and seven patients aged 3 years and over with acute illness (21 days or less) presenting with cough as the main symptom plus at least one symptom or sign from sputum, chest pain, dyspnoea, or wheeze were recruited to the study. Main outcomes were duration of symptoms (rated at least a slight problem) and more severe symptoms (rated at least moderately bad). RESULTS: The average duration of cough (rated at least a slight problem) was 11.7 days and was shorter among children (duration -1.72 days; 95% confidence interval [CI] = -3.02 to -0.41) or in individuals with a history of fever (-1.22 days; 95% CI = -0.18 to 2.27). The duration of cough was longer among those with restricted activities on the day they saw the doctor (+0.69 days for each point of a 7-point scale). The duration of more severe symptoms was longer in those with a longer duration of symptoms prior to consultation, with a more severe cough on the day of seeing the doctor, and restriction of activities on the day of seeing the doctor. CONCLUSION: Illness duration may be predicted from a limited number of clinical symptoms and from prior history. These findings should be subjected to validation in a separate population. To minimise expectation about rapid resolution of illness, adults who have restricted activities could be advised that they are likely to experience symptoms for longer.     

Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial

Background

Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled “Join2move”. The Join2move intervention is a self-paced 9-week PA program in which the patient’s favorite recreational activity is gradually increased in a time-contingent way.

Objective

The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group.

Methods

The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control.

Results

Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI −1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group.

Conclusions

Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.

Trial Registration

The Netherlands National Trial Register: NTR2483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2483 (Archived by WebCite at http://www.webcitation.org/67NqS6Beq).     

Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men

BACKGROUND: Post-exposure prophylaxis (PEP) is currently recommended after certain high-risk exposures, and pre-exposure prophylaxis (PrEP) is undergoing evaluation in clinical trials. Media reports have suggested substantial levels of community PrEP use despite its unproven effectiveness. METHODS: We conducted a cross-sectional survey of 1819 HIV-uninfected gay/bisexual men in California to assess PEP and PrEP awareness and use. RESULTS: Overall, 47% reported PEP awareness and 4% ever used PEP. Men who were older than 25 years of age (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.5 to 3.1), were white (OR = 2.2, 95% CI: 1.6 to 3.0), had an annual income >$100,000 (OR = 2.0, 95% CI: 1.2 to 3.4), self-identified as gay/homosexual (OR = 2.4, 95% CI: 1.4 to 4.3), and had unprotected anal sex (OR = 1.8, 95% CI: 1.3 to 2.3) or sex under the influence of a drug (OR = 2.0, 95% CI: 1.5 to 2.7) were more likely to be aware of PEP, whereas speed users (OR = 0.6, 95% CI: 0.4 to 0.9) were less likely to be aware of PEP. Only 16% reported PrEP awareness, and <1% ever used PrEP. Unprotected anal sex (OR = 1.6, 95% CI: 1.1 to 2.3) and sex under the influence of a drug (OR = 1.5, 95% CI: 1.0 to 2.2) were associated with PrEP awareness. CONCLUSIONS: PEP awareness and use were modest and PrEP use was rare among gay/bisexual men in California. Although PrEP is not currently recommended, community education on the availability of PEP is suggested.     

Preferences in trust regarding the provision of cancer information among adults

Background: Disparities associated with trust in health information exist warranting a need for research assessing this relationship among adults. Therefore, the aim of this study was to assess trust of cancer information among U.S. adults.Methods: A weighted sample of 237,670,167 adults from the Health Information National Trends Survey (HINTS) from 2011-2014 was used for the analyses. Dependent variables were dichotomized answers to whether individuals trusted information from family/friends, the internet, or a doctor. Independent variables included age, sex, region, race/ethnicity, and cancer diagnosis to investigate associations between demographic factors and differences in trust. Logistic regression was run using R survey package.Results: There were statistically significant differences in trust based on race/ethnicity, age, and cancer diagnosis. Minorities were less likely to trust information from a doctor, with Hispanics more likely to trust information from the internet (OR=1.8 (95% CI 1.36,2.43)), and Non-Hispanic Blacks trusting information from family and friends (OR=1.5 (95% CI 1.06, 2.13)). Adults ≥45 years of age were less likely to trust the doctor ‘a lot’ (45-64 years: OR=0.6 (95% CI 0.50, 0.83); 65+ years (OR=0.7 (95% CI 0.54, 0.92)), but more likely to not trust information from family and friends or the internet. Patients with cancer were more likely to trust information from a doctor ‘a lot’ (78%; p=0.01).DiscussionSignificant differences in preferences regarding trust in cancer information occurred based on sociodemographic characteristics.Conclusion: These finding suggest targeting specific population subgroups for information from sources they trust could be helpful in reducing disparities in trust.     

Predicting self-reported functional improvement one year after primary total knee arthroplasty using pre- and postoperative patient-reported outcome measures

BackgroundApproximately 20% of patients do not perceive functional improvement after a primary total knee arthroplasty (TKA). This study aims to assess which patient-related and clinical determinants at baseline and six months postoperative can predict lack of self-reported functional improvement at 12 months after primary TKA.MethodsIn a retrospective cohort study of 569 patients who received a primary TKA between 2015 and 2018, self-reported functional improvement, measured as ≥ 7 points increase in Oxford Knee Score (OKS) from baseline to 12 months postoperative, was assessed. Patient characteristics and patient-reported variables at baseline and six months postoperative were entered in a logistic regression model with manual backward elimination.ResultsIncidence of functional improvement in this study was 73%. Preoperative variables were no strong predictors of the outcome. An increase in pain between baseline and six months postoperative was a risk factor for not functionally improving (odds ratio (OR) 1.13 (95% confidence interval (CI) 1.03–1.23)). An improvement in knee pain and function was a protective factor for lacking functional improvement (OR 0.78 (95% CI 0.74–0.82)). The prediction model explained 44% of variance and showed good calibration and discrimination. Sensitivity and specificity were 82% and 76%, respectively.ConclusionsUsing pre- and postoperative variables, a prediction model for self-reported functional improvement one year after TKA was developed. This prediction tool was easy to use at six months postoperative and allowed identification of patients at high risk for not functionally improving one year after TKA. This could facilitate early interventions directed at functional improvement after TKA.     

Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: a randomised controlled trial in primary care

Background

The effectiveness of diclofenac versus paracetamol in primary care patients with pain caused by knee osteoarthritis is unclear.

Aim

To assess the effectiveness of diclofenac compared with paracetamol over a period of 2, 4, and 12 weeks in patients with knee osteoarthritis.

Design and setting

Randomised controlled trial in general practice.

Method

There were 104 patients included in the study, they were aged ≥45 years consulting their GP with knee pain caused by knee osteoarthritis. Patients were randomly allocated to diclofenac (n = 52) or paracetamol (n = 52) for at least 2 weeks. Primary outcomes were daily knee pain severity, and knee pain and function measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results

Over a period of 2- and 4-weeks follow-up, no significant difference in daily knee pain was found between the patient groups: estimated differences of 0.5 (95% CI = −0.2 to 1.3) and −0.2 (95% CI = −1.0 to 0.7), respectively. Over the 12-weeks follow-up, no significant differences were found between both groups for KOOS pain: estimated difference of −2.8 (95% CI = −10.7 to 5.1) and KOOS function of −2.7 (−10.6 to 5.0).

Conclusion

Over a period of 2- and 4-weeks follow-up no significant difference in daily measured knee pain severity was found between primary care patients with knee osteoarthritis taking paracetamol or diclofenac. Also, over a period of 12-weeks follow-up no significant differences were found regarding KOOS pain and KOOS function between both groups. Patients more frequently reported minor adverse events after taking diclofenac (64%) than paracetamol (46%).