General practitioners miss disability and anxiety as well as depression intheir patients with osteoarthritis

Background. General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors. Aim. To determine functional disability, psychological morbidity, social si tuation, and use of health and social services in patients with osteoarthri tis and examine GP knowledge of these factors. Method. Two hundred patients completed a validated postal questionnaire abo ut functional disability (Health Assessment Questionnaire [HAQ]), mood (Hos pital Anxiety and Depression Scale [HAD]), employment status, who they live d with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety. Results, Forty-seven per cent of patients were moderately or severely disab led (HAQ>1). GPs underestimated functional disability: mean patient HAQ = 1 .04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores ( kappa = 0.24). There was moderate prevalence of depression and high prevale nce of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4. 1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kap pa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11. 9% (95% CI = 69%-16.9%), kappa = 0.19. Only 46% of severely disabled patien ts (HAQ>2) were receiving disability welfare benefits. GPs were often unawa re of welfare benefits received or the involvement of other professionals. Conclusion. GPs frequently lack knowledge about functional disability, soci al factors, and anxiety as well as depression in their patients with osteoa rthritis.