Factors Associated With Referral to Secondary Care in Patients With Osteoarthritis of the Hip or Knee After Implementation of a Stepped-Care Strategy

Objective. We introduced a stepped-care strategy (SCS) for hip and knee osteoarthritis, focusing on delivery of highquality stepped care. In this study, we aimed to identify factors associated with various steps of the SCS. Methods. We used data from a 2-year observational prospective cohort study, including 313 patients visiting their general practitioner (GP) with a new episode of hip/knee osteoarthritis. We used logistic multilevel analyses to identify factors at the level of the patient, the GP, and the general practice, related to treatment limited to primary care, referral to nonsurgical secondary care, or surgical procedures.