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PATIENT CARE PROCESS

Patient Care Process for the Management of Osteoarthritis

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Collect

  • Patient characteristics (e.g., age, weight, height, race, sex, pregnant)

  • Patient history (past medical, family, social, and alcohol use)

  • Symptom information: type and location of pain; duration; effect of motion and rest; range of motion and limitations on activities; instability

  • Current and past medications, including nonprescription agents and dietary supplements, and medications' relief of symptoms

  • Objective data (see Box 90-1)

    • Physical examination; appearance of joints

    • Radiologic evaluation—changes in joints; subchondral bone sclerosis; effusions (see Box 90-3)

    • Body mass index (presence of overweight or obesity)

    • Presence of renal or hepatic disease

Assess

  • Distribution and severity of joint involvement

  • Impact of symptoms on patients' daily activities, interference with occupational functioning, health-related quality of life

  • Effects of pre-existing renal or hepatic disease on choice of medication selection and dose

Plan*

  • Patient education about disease, prognosis, treatment options, application and use of topical products

  • Nonpharmacologic therapy (see Table 90-1)—weight loss (if overweight or obese), exercise, surgery (for severe pain or functional disability)

  • Drug therapy regimen including specific analgesics, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figures 90-4 and 90-5 and Tables 90-2 and 90-3)

  • Monitoring parameters including efficacy (e.g., symptom relief), safety (medication-specific adverse effects) (see Table 90-3)

  • Self-monitoring of symptoms, exercise, and weight—where and how to record results

  • Referrals to other providers when appropriate (e.g., physician, orthopedic surgeon, physical therapist)

  • Consider joint replacement if patient has severe pain or significant functional impairment, or drug therapy is ineffective or poorly tolerated.

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence. This is particularly important for nonpharmacologic interventions.

  • Schedule follow-up monthly until symptoms controlled to assess efficacy of drug therapy regimen and assess adherence to nonpharmacologic interventions.

Follow-up: Monitor and Evaluate

  • Assess symptom relief, effectiveness of weight loss and exercise programs

  • Presence of adverse effects (see Table 90-3), including cardiovascular and renal effects of NSAIDs, hepatic effects of acetaminophen and glycemic effects of intraarticular corticosteroids.

  • Closely monitor proper use of opioids in all patients, including dependence, addiction, tolerance, hyperalgesia, and diversion (see text).

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 2. Osteoarthritis.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Millions of Americans have osteoarthritis (OA). OA prevalence increases with age and number of other chronic conditions, with women more commonly affected than men.

  • Image not available. Contributors to OA are systemic (age, genetics, hormonal status, obesity, occupational, or recreational activity) and/or local (injury, overloading of joints, muscle weakness, or joint deformity).

  • Image not available. OA is primarily a disease of cartilage that reflects a failure of the chondrocyte to maintain proper balance between cartilage formation and destruction. This leads ...

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