关节置换未满足的需求：对髋部和膝部严重疼痛及残疾个体治疗障碍的定性调查。
Unmet need for joint replacement: a qualitative investigation of barriers to treatment among individuals with severe pain and disability of the hip and knee.
作者信息
Sanders C, Donovan J L, Dieppe P A
机构信息
Health Economics Research at Manchester (HERaM), School of Psychiatry and Behavioural Sciences, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
出版信息
Rheumatology (Oxford). 2004 Mar;43(3):353-7. doi: 10.1093/rheumatology/keh044. Epub 2003 Nov 17.
OBJECTIVE
To explore barriers to health-care utilization in respondents with moderate to severe hip/knee symptoms of pain and disability.
METHODS
In-depth interviews were carried out with 27 participants who had high levels of hip/knee pain and disability (according to New Zealand scores). There were 10 men and 17 women; median age 76 yr (range 51-91). The data were analysed thematically using the constant comparison technique.
RESULTS
Three types of barrier were identified: (i) people's own perceptions of need and reluctance to seek treatment, (ii) perceptions and experiences of primary care and (iii) experiences of treatment in secondary care. Pessimism about availability of treatments, and concerns about effectiveness and risks of surgery, made older people reluctant to seek medical help. Such views were often confirmed by GPs. Some of those referred to a hospital specialist were told that they were too young or too mobile for surgery.
CONCLUSION
Barriers to treatment and unmet need for joint replacement exist in the UK, particularly amongst older people.
目的
探讨有中度至重度髋部/膝部疼痛及功能障碍症状的受访者在医疗保健利用方面的障碍。
方法
对27名髋部/膝部疼痛及功能障碍程度较高（根据新西兰评分）的参与者进行了深入访谈。其中男性10名，女性17名；年龄中位数为76岁（范围51 - 91岁）。采用持续比较技术对数据进行主题分析。
结果
确定了三种类型的障碍：（i）人们自身对需求的认知以及不愿寻求治疗，（ii）对初级保健的认知和体验，以及（iii）二级保健中的治疗体验。对治疗可及性的悲观态度，以及对手术有效性和风险的担忧，使老年人不愿寻求医疗帮助。全科医生的意见往往证实了这些观点。一些被转诊至医院专科医生处的患者被告知，他们年龄太小或活动能力太强，不适宜进行手术。
结论
在英国，存在治疗障碍以及关节置换需求未得到满足的情况，尤其是在老年人中。
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