Osteoarthritis management care pathways are complex and inefficient: A qualitative study of physiotherapist perspectives from specialised osteoarthritis services

Abstract

Objective Hip and knee osteoarthritis guidelines internationally provide consistent first‐line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline‐based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care. Methods Nineteen semi‐structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n = 10; OsteoArthritis Chronic Care Programme n = 4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n = 5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis. Results The overarching theme to emerge was that accessing first‐line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co‐morbidities is challenging. Conclusion Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first‐line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.

Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey

“…Strategies were rated by a larger number of respondents than is typical of most Delphi studies to ensure that participants reflected varied perspectives of women and professionals from across Canada to generate national consensus, and because larger sample size has been shown to enhance reliability 27 28. Prioritised strategies reflect strong consensus within and across groups of women and professionals, and because they are multilevel, stand to address barriers identified at the patient-level, clinician-level and system-level 14 15 18–21. We must also mention potential study limitations.…”

“…This may overcome patient-level barriers such as lack of knowledge about OA or self-management, but are unlikely to address additional known barriers at the healthcare professional (eg, OA not considered serious) or system level (eg, availability of support services) that contribute to gendered inequities in access to and quality of OA care 14 15. Furthermore, research shows that self-management programmes have minimal, non-sustained impact on patient OA knowledge, self-efficacy, behaviour and symptoms18 unless self-management is facilitated by physicians via person-centred approaches including ongoing counselling, tailored action plans and referral to other sources of OA management or support 19 20. However, research involving healthcare professionals in five countries identified challenges to person-centred OA care: healthcare professionals lack knowledge of how to manage OA, their personal beliefs differ from guideline recommendations and they perceive that patients have unrealistic expectations 21…”

“… 14 15 Furthermore, research shows that self-management programmes have minimal, non-sustained impact on patient OA knowledge, self-efficacy, behaviour and symptoms 18 unless self-management is facilitated by physicians via person-centred approaches including ongoing counselling, tailored action plans and referral to other sources of OA management or support. 19 20 However, research involving healthcare professionals in five countries identified challenges to person-centred OA care: healthcare professionals lack knowledge of how to manage OA, their personal beliefs differ from guideline recommendations and they perceive that patients have unrealistic expectations. 21 …”

Usage of guideline-adherent core treatments for knee osteoarthritis before and after consulting an orthopaedic surgeon: A prospective cohort study

“…Our dietary weight management criterion was stricter as we had asked patients whether they had received a diet or dietary weight management with a dietician. As the costs for dietary treatment and most often exercise are not covered by the national health security system in Denmark, there may have been a financial barrier for undertaking dietary weight management and exercise [ 37 , 38 ]. Altogether, patients with knee OA undertake a large variety of treatments, often not in accordance with clinical guidelines.…”

Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines

“…Instead, self-management is more effective when nurtured by physicians who practice person-centred care (PCC) through approaches such as one-on-one patient-provider consultation, tailoring a multi-pronged action plan to patient needs, providing or referring to sources of self-help; and ongoing monitoring and follow-up to assess OA status and goals, and modify the action plan as required [ 18 ]. However, clinicians have reported difficulty in providing person-centred OA care and self-management advice [ 19 ]. Therefore, solely placing responsibility on patients to self-manage OA is not likely to reduce gendered inequities in OA care, and instead, research is needed on how to support clinicians in providing equitable, person-centred OA care.…”