Pharmacist identification of new, diagnostically–confirmed, osteoarthritis (PHIND-OA)

Project Description:

Many people with knee pain actually have knee osteoarthritis (OA) - but they don’t know it. So UBC researchers thought of a new way to find people with knee OA and help them get treatment. Their strategy? Pharmacists. Pharmacists see many people regularly, so having pharmacists ask about knee pain might make a big difference in finding knee OA. This study looked at how many people pharmacists found and how many people with knee pain actually had knee OA.

Why Do This Research?

At first, knee OA doesn’t have a lot of symptoms. This is why most people don’t know they have it - and why they don’t see a doctor for treatment. But when knee OA is left untreated, symptoms like stiffness, pain, and swelling worsen. This is why knee OA is a major cause of disability, particularly among older people.

The best treatment for knee OA is an exercise program, weight loss and the right medication. Together, this can prevent pain and disability from knee OA and can limit side effects from medications. But because most people are unaware they have knee OA, few patients receive proper treatment.

For these reasons, UBC researchers wanted a new way to find people with knee OA and help them get treatment. Since patients see their pharmacists more often than their doctors, researchers decided to have pharmacists ask people about knee pain. Pharmacists have been taking on a bigger role in health care, which made it a good time to start work with pharmacists. Researchers knew pharmacists had recently helped improve diabetes treatment¹, but it was a new idea to involve pharmacists in finding OA.

What made this study new and exciting was that it was a simple idea, but one that could really work. Pharmacists are experts in medications, including the over-the-counter products people often use for knee pain. Pharmacists are also seen on a regular basis by many people- and an appointment isn’t necessary to get your pharmacist’s advice.

More people are developing knee OA than ever before, and treatment is important for patients to feel better and stay active. Left untreated, knee OA and disability create more health care costs. So finding knee OA is a small start to a big difference, both to how patients feel and to the health care system.

¹ Garrett, DG & Bluml, BM. Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes. J Am Pharm Assoc (2003). 2005 Mar-Apr;45(2):130-7.

Who is Being Studied?

This study focused on people who have knee pain, but who have never been told by a doctor they have knee OA. People with a recent knee injury, any knee surgery, or a diagnosis of certain diseases, like rheumatoid arthritis, were asked not to participate in the study.

How Was It Done?

Posters were placed in pharmacies encouraging people who have knee pain to tell the pharmacist. With every person who mentioned knee pain, pharmacists went through two questionnaires. These questionnaires helped pharmacists decide if the person’s knee pain was likely knee OA and if the person was eligible to participate in the study. People who were eligible and who gave their consent became participants in the study.

Pharmacists took contact information from participants, including the name of their family doctor. A study coordinator contacted the participant’s family doctor to double-check if the doctor had already diagnosed the participant with knee OA. If not, participants were contacted by a study coordinator to schedule an appointment at the Arthritis Centre.

During their visit at the Arthritis Centre, participants received an X-ray and a knee exam. This was done by an OA doctor or physiotherapist who specializes in OA. The OA doctor or physiotherapist also reviewed the patient’s history.

For patients who were diagnosed with knee OA, the X-ray results were sent to the participant’s family doctor. Participants were given a letter encouraging them to visit their family doctor so they could start treatment. Participants were also given a package from the Arthritis Society to help them manage their knee OA.

What Was Found?

During the study, 411 people mentioned knee pain to the pharmacists. Of these, pharmacists thought that 274 people were eligible to participate and were likely to have knee OA, based on their answers the questionnaires. Some of these (46 people) chose not to participate in the study or had to stop for other reasons. Also, 34 people that the pharmacists thought could participate were not actually eligible according to researchers. In total, 194 participants went on to receive a knee exam and X-ray at the Arthritis Centre. Of the 194 participants, 190 received a diagnosis of knee OA (98%).

The final results of the study were reported in Arthritis and Rheumatism, Volume 57, Number 7, October 15, 2007 (pages 1238–1244). The researchers commented that the study shows that pharmacists are a very effective way of finding people with knee OA.

Why is this Relevant to People Living with Arthritis?

This is an important study to people who are living with knee pain, but do not yet know it is arthritis. The study raises awareness about knee OA and gives a strategy to help people with knee OA be diagnosed and treated.

Were Consumers Involved?

Consumers (through Arthritis Consumer Experts) were contacted for their input on study design, study recruitment and knowledge translation activities. Questions to be answered by consumer representatives:

• Which Consumers are/have been most appropriate for this project?
• From the consumer’s perspective, how are consumer collaborators contributing to this project?

Who Helped Pay for the Research?

This project was funded by the Arthritis Research Centre of Canada, the Michael Smith Foundation for Health Research, a CIHR NET grant and Merck Frosst.

Publications / Presentations

Marra, C., et al. Improving Osteoarthritis Detection in the Community: Pharmacist Identification of New,Diagnostically Confirmed Osteoarthritis. Arthritis & Rheumatism,Vol. 57, No. 7, October 15, 2007, pp 1238–1244.

Grindrod KA, Marra CA, Colley L, Cibere J, Tsuyuki RT, Esdaile JM, Gastonguay L, Kopec J. After patients are diagnosed with knee osteoarthritis, what do they do? Arthritis Care Res (Hoboken). 2010 Apr;62(4):510-5.

Team Members

Principal Investigator:

Carlo A. Marra  Pharm,D PhD

Other TUFEOA Investigators:

Jolanda Cibere  MD, PhD
John M. Esdaile  MD, MPH
Aslam H. Anis  PhD

University of Alberta Team

Ross T. Tsuyuki  PharmD, MSc
Walter Maksymowych  MD
Gilbert Enenajor  MD

If you want to participate or know more, please contact Dr. Carlo Marra at This e-mail address is being protected from spambots. You need JavaScript enabled to view it