Ibrahim Said A, Hanusa Barbara H, Hannon Michael J, Kresevic Denise, Long Judith, Kent Kwoh C
Philadelphia VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia 19104, USA.
Arthritis Rheum. 2013 May;65(5):1253-61. doi: 10.1002/art.37899.
African American patients are significantly less likely to undergo knee replacement for the management of knee osteoarthritis (OA). Racial difference in preference (willingness) has emerged as a key factor. This study was undertaken to examine the efficacy of a patient-centered educational intervention on patient willingness and the likelihood of receiving a referral to an orthopedic clinic.
A total of 639 African American patients with moderate-to-severe knee OA from 3 Veterans Affairs primary care clinics were enrolled in a randomized, controlled trial with a 2 × 2 factorial design. Patients were shown a knee OA decision-aid video with or without brief counseling. The main outcome measures were change in patient willingness and receipt of a referral to an orthopedic clinic. Also assessed were whether patients discussed knee pain with their primary care provider or saw an orthopedic surgeon within 12 months of the intervention.
At baseline, 67% of the participants were definitely/probably willing to consider knee replacement, with no difference among the groups. The intervention increased patient willingness (75%) in all groups at 1 month. For those who received the decision aid intervention alone, the gains were sustained for up to 3 months. By 12 months postintervention, patients who received any intervention were more likely to report engaging their provider in a discussion about knee pain (92% versus 85%), to receive a referral to an orthopedic surgeon (18% versus 13%), and for those with a referral, to attend an orthopedic consult (61% versus 50%).
An educational intervention significantly increased the willingness of African American patients to consider knee replacement. It also improved the likelihood of patient-provider discussion about knee pain and access to surgical evaluation.
非裔美国患者因膝关节骨关节炎（OA）接受膝关节置换术的可能性显著较低。偏好（意愿）方面的种族差异已成为一个关键因素。本研究旨在检验以患者为中心的教育干预对患者意愿以及获得骨科诊所转诊可能性的效果。
来自3家退伍军人事务初级保健诊所的639名患有中重度膝关节OA的非裔美国患者被纳入一项采用2×2析因设计的随机对照试验。患者观看了有或没有简短咨询的膝关节OA决策辅助视频。主要结局指标为患者意愿的变化以及获得骨科诊所转诊的情况。还评估了患者在干预后12个月内是否与初级保健提供者讨论过膝关节疼痛或是否看过骨科医生。
在基线时，67%的参与者肯定/可能愿意考虑膝关节置换，各小组之间无差异。干预在1个月时提高了所有小组的患者意愿（75%）。对于仅接受决策辅助干预的患者，这种提升持续了长达三个月。到干预后12个月时，接受任何干预的患者更有可能报告与提供者讨论过膝关节疼痛（92%对85%），获得骨科医生的转诊（18%对13%），并且对于那些获得转诊的患者，更有可能参加骨科会诊（61%对50%）。
教育干预显著提高了非裔美国患者考虑膝关节置换的意愿。它还提高了患者与提供者讨论膝关节疼痛以及获得手术评估的可能性。
