To identify gaps in current osteoarthritis (OA) care in Quebec, Canada, and to implement and evaluate interventions to promote appropriate use of evidence-based medicine.
Pretest and posttest; analysis of the Quebec health insurance database.
CURATA is a patient health management program utilizing an evidence-based approach for OA treatment. Evaluation of the current level of care revealed major gaps in physicians' knowledge of (1) risk factors for gastrointestinal (GI) toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs); (2) NSAID-induced toxicity associated with long-term administration and contraindications for NSAID use in patients with hypertension, cardiovascular disease, or renal insufficiency; (3) choice of cytoprotection; and (4) use of nonpharmacologic treatments for OA. The CURATA intervention consisted of educational workshops, with and without presentation of a decision tree regarding appropriate use of pharmacologic and nonpharmacologic OA treatments. Participating physicians were asked to complete an 8-item questionnaire before and after the workshop, as well as 3 and 6 months later, to test their immediate and remote knowledge of treatment choices. The prescribing patterns of GPs also were evaluated through analysis of the Quebec health insurance database.
The participating physicians were better immediate and remote risk assessors of GI bleeding and made more appropriate treatment choices (15.2% improvement relative to mean preworkshop score).
These evidence-based interventions were successful not only in improving the physicians' knowledge regarding the diagnosis and management of OA, but also--more importantly--in changing their behavior to make more appropriate therapy choices for their patients.