Barriers for guideline adherence in knee osteoarthritis care: A qualitative study from the patients' perspective

Abstract

Rationale, aims and objectives Guidelines for patients with knee osteoarthritis (OA) are suboptimally implemented in clinical care. To improve guideline adherence, patients' perceived barriers and facilitators in current care were investigated.Methods Eleven patients with knee OA were extensively interviewed using a semistructured script based on quality indicators. Directed content analysis, within the framework of Grol and Wensing, was performed to describe barriers and facilitators in 6 domains: guideline, health care professional, patient, social environment, organization, and financial context. Data were analyzed using NVIVO 10 software. ResultsIn total, 38 barriers, at all 6 domains, were identified. The most frequently mentioned barriers were in the domains of the patient and the health care professional, namely, patients' disagreement with guidelines recommendations, negative experience with drugs, patients' limited comprehension of the disease process, and poor communication by the health care professional.The patients' disagreement with recommendations is further explained by the following barriers:"insistence on medical imaging," "fear that physiotherapy aggravates pain," and "perception that knee OA is not a priority health issue". Patients also reported 20 facilitators, all of which are listed as opposing barriers. There is thus a clear need for interventions to improve guideline adherence to obtain optimal care for the patients. However, to allow effective intervention strategies, first qualitative research is needed that addresses possible barriers and facilitators to guideline adherence in current care. 17 To date, barriers and facilitators have mainly been studied from the health care professionals' perspective. 18 However, patients play a crucial role in upgrading care to better guideline adherence as their experiences, preferences, concerns, and care management can substantially influence the decision-making process for optimal knee OA management. Conclusions 19-21Therefore, the aim of this study was to investigate barriers and facilitators in current care of knee OA from the patients' perspective.2 | METHODS | Study designTo identify barriers and facilitators in the management of knee OA, semistructured face-to-face interviews were conducted with patients.The interview script was based on the Belgian set of quality indicators. 16 This study was described in accordance with the consolidated criteria for reporting Qualitative Research (COREQ checklist). 22 | Study populationPatients with knee OA were recruited in 3 different settings: from the interviewers' (JD) general practice population, from the patient population of GP practices in the same region, and finally by an advertisement in the monthly magazine of the national federation for patients with rheumatic diseases. In the GP settings, a search was performed by the GP in the electronic health record to select eligible patients with a diagnosis of knee OA.The inclusion criteria for this study were as follows: (1) clinical and/or ra...

Qualitative study exploring the factors influencing physical therapy management of early knee osteoarthritis in Canada

“…This is consistent with studies of people with OA which found that some people have fears that exercise is damaging to their joints 50 or will worsen pain. 51 Overcoming misconceptions about OA may require more emphasis on public education that highlights the early signs and symptoms, de-emphasises the need for X-ray findings to diagnose early OA, challenges the assumption that all OA is inevitably progressive and explains the benefits of exercise. Effective, collaborative patient-provider communication about OA management is also crucial.…”

Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines

“…From the patient perspective, a qualitative study of patients with osteoarthritis of the knee [32] found that poor comprehension of the disease process, negative experiences with drug therapies, poor communication by the health professional and disagreement with the recommendations of guidelines, presented key barriers to adherence. Within those disagreements an insistence on medical imaging and a fear that physiotherapy aggravates pain were important issues.…”

The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group

“…We can divide barriers to adhering to OA treatment guidelines into four themes: “OA is not that serious,” reflecting an attitude that everybody eventually gets OA as they grow older, “Clinicians are, or perceive they are, under-prepared,” “Personal beliefs at odds with providing recommended practice,”, and “Dissonant patient expectations” [ 11 ]. Factors that facilitate improved adherence to the guidelines are patient-tailored strategies to improve patients’ knowledge, self-management, and communication with healthcare professionals on matters such as shared decision making [ 12 ]. To overcome the discrepancy between the guidelines and practice, a nationwide program titled “Better management of patients with osteoarthritis” (BOA) was initiated in Sweden in 2008 to offer information and individually adapted exercise to all patients with hip and knee OA, in accordance to guidelines for OA [ 13 ].…”