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Title: Modelling clinical outcomes and cost-effectiveness of primary care interventions for osteoarthritis using prediction and decision models
Author: Wulff, Jerome
Awarding Body: Keele University
Current Institution: Keele University
Date of Award: 2013
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The overall aim of this thesis is to develop prediction models to identify key predictors of poor outcome in people with osteoarthritis (OA) and examine the cost effectiveness of two approaches to delivering primary care interventions for OA compared to current primary care. This thesis is comprised of two parts – the first part concerns the development of prediction models to identify the combination of factors that predicts poor outcome of OA in relation to pain and functional limitation at three year follow up for participants aged 50 years or more. The strongest baseline predictors of pain and functional disability were having pain in the previous year and poor physical function at baseline respectively. The models developed showed good internal validity and hence may be further tested for external validity in community-based adults with similar characteristics as those in this study. The second part involves a summary of evidence on the effectiveness of four primary care interventions (information and advice, simple analgesia, topical NSAIDs and exercise) in reducing pain and improving function at one or more joint sites among osteoarthritis patients in primary care. The results showed significant small to moderate improvements in pain and functional disability for advice/information, topical NSAIDs and exercise interventions compared to their controls, whilst simple analgesia failed to demonstrate significant improvements in either measures. This evidence was used to populate the economic (decision) model developed in this thesis. The decision model examined the cost effectiveness of two approaches to delivering primary care interventions for OA - stepped care and one-stop-shop care were compared with current primary care. The primary results were robust to changes in the input v variables with stepped care emerging as the most cost-effective option ahead of one-stop-shop care and current care in that order. These findings need to be confirmed in samples of primary care consulters.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General)