基层医疗医生对于决定哪些患者应转诊接受髋膝关节全关节置换术的看法及信心。

Primary care physicians' perceptions about and confidence in deciding which patients to refer for total joint arthroplasty of the hip and knee.

作者信息

Waugh E J, Badley E M, Borkhoff C M, Croxford R, Davis A M, Dunn S, Gignac M A, Jaglal S B, Sale J, Hawker G A

机构信息

Women's College Hospital, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

出版信息

Osteoarthritis Cartilage. 2016 Mar;24(3):451-7. doi: 10.1016/j.joca.2015.09.017. Epub 2015 Oct 23.

DOI:10.1016/j.joca.2015.09.017

PMID:26432986

Abstract

OBJECTIVE

The purpose of this study is to examine the perceptions of primary care physicians (PCPs) regarding indications, contraindications, risks and benefits of total joint arthroplasty (TJA) and their confidence in selecting patients for referral for TJA.

DESIGN

PCPs recruited from among those providing care to participants in an established community cohort with hip or knee osteoarthritis (OA). Self-completed questionnaires were used to collect demographic and practice characteristics and perceptions about TJA. Confidence in referring appropriate patients for TJA was measured on a scale from 1 to 10; respondents scoring in the lowest tertile were considered to have 'low confidence'. Descriptive analyses were conducted and multiple logistic regression was used to determine key predictors of low confidence.

RESULTS

212 PCPs participated (58% response rate) (65% aged 50+ years, 45% female, 77% >15 years of practice). Perceptions about TJA were highly variable but on average, PCPs perceived that a typical surgical candidate would have moderate pain and disability, identified few absolute contraindications to TJA, and overestimated both the effectiveness and risks of TJA. On average, PCPs indicated moderate confidence in deciding who to refer. Independent predictors of low confidence were female physicians (OR = 2.18, 95% confidence interval (CI): 1.06-4.46) and reporting a 'lack of clarity about surgical indications' (OR = 3.54, 95% CI: 1.87-6.66).

CONCLUSIONS

Variability in perceptions and lack of clarity about surgical indications underscore the need for decision support tools to inform PCP - patient decision making regarding referral for TJA.

摘要

目的

本研究旨在调查基层医疗医生（PCP）对全关节置换术（TJA）的适应症、禁忌症、风险和益处的看法，以及他们在选择TJA转诊患者时的信心。

设计

从为一个既定社区队列中患有髋或膝骨关节炎（OA）的参与者提供护理的医生中招募PCP。使用自我填写的问卷收集人口统计学和执业特征以及对TJA的看法。对将合适患者转诊至TJA的信心采用1至10分制进行衡量；得分处于最低三分位数的受访者被视为“信心低”。进行描述性分析，并使用多元逻辑回归确定信心低的关键预测因素。

结果

212名PCP参与了研究（回复率为５８％）（65％年龄在50岁及以上，45％为女性，77％执业超过15年）。对TJA的看法差异很大，但平均而言，PCP认为典型的手术候选人会有中度疼痛和残疾，确定的TJA绝对禁忌症很少，并且高估了TJA的有效性和风险。平均而言，PCP表示在决定转诊对象时信心中等。信心低的独立预测因素是女医生（比值比（OR）=2.18，95％置信区间（CI）：1.06-4.46）以及报告“手术适应症不明确”（OR = 3.54，95％CI：1.87-6.66）。