Health care practices in symptomatic knee and hip osteoarthritis patients in primary care: the KHOALA cohort.

Objective: To describe the health care use of patients with symptomatic knee or hip OA and to identify factors associated with health care use trajectories over a 10-year period.

Methods: This study used longitudinal data from the multicentre "Knee-and-Hip-OsteoArthritis-Long-term-Assessment" cohort, which comprised 878 patients with OA diagnoses confirmed by both a physician and radiographic evidence. We identified homogeneous subgroups of trajectories based on individual health care consumption over time via latent class growth analysis. Logistic regression analysis determined baseline factors associated with these trajectories.

Results: A minority of patients consulted a specialist. Impaired mental health was associated with moderate- and high-probability trajectories of consulting a primary care physician (PCP), a physical therapist and a rheumatologist (ORs 0.7 [0.6-0.9] to 0.9 [0.8-0.96]). High pain levels were associated only with high probability of consulting an orthopaedic surgeon (OS) (OR 0.8 [0.7-0.9]). Rheumatologist consultations were more likely in large cities (OR 2.3 [1.3-4.1]), and OS consultations were associated with a high level of education (OR 3.6 [1.3-7.4]).

Conclusions: PCPs play a central role in OA care. High pain levels were associated mainly with a high probability of consulting an OS, whereas mental health status was a major predictive factor of other health care professional consultations. Mental health state is probably insufficiently accounted for. Social inequalities persist and must be considered in public health policies.