Enhancing Alberta Primary Care Research Networks (EnACt), Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
BMJ Open. 2019 Feb 1;9(1):e024016. doi: 10.1136/bmjopen-2018-024016.
OBJECTIVE: To elicit perspectives of family physicians and patients with knee osteoarthritis (KOA) on KOA, its treatment/management and the use of a mobile health application (app) to help patients self-manage their KOA. DESIGN: A qualitative study using Cognitive Task Analysis for physician interviews and peer-to-peer semistructured interviews for patients according to the Patient and Community Engagement Research (PaCER) method. SETTING: Primary care practices and patient researchers at an academic centre in Southern Alberta. PARTICIPANTS: Intentional sampling of family physicians (n=4; 75% women) and patients with KOA who had taken part in previous PaCER studies and had experienced knee pain on most days of the month at any time in the past (n=5; 60% women). RESULTS: Physician and patient views about KOA were starkly contrasting. Patient participants expressed that KOA seriously impacted their lives and lifestyles, and they wanted their knee pain to be considered as important as other health problems. In contrast, physicians uniformly conceptualised KOA as a relatively minor health problem, although they still recognised it as a painful condition that often limits patients' activities. Consequently, physicians did not regard KOA as a condition to be proactively and aggressively managed. The gap between physicians' and patients' conceptualisation of KOA and its treatment extended to the use of an app for self-management. While patients were supportive of the app, physicians were sceptical of its use and focused more on accountability and patient resources. CONCLUSIONS: The clear discord between physicians' mental models and patients' lived experience and perceived needs around KOA emphasised a gap in understanding and communication about treatment and management of KOA. As such, this preliminary and formative research will inform a codesign approach to develop an app that will act as a communications tool between patients and physicians, enabling patient-physician discussions regarding modifiable self-management options based on a patient's perspectives and needs.
目的：了解家庭医生和膝骨关节炎（KOA）患者对 KOA 的看法、其治疗/管理以及使用移动健康应用程序（app）帮助患者自我管理 KOA 的看法。
设计：根据患者和社区参与研究（PaCER）方法，对家庭医生进行认知任务分析访谈，对患者进行同伴对同伴半结构化访谈的定性研究。
地点：艾伯塔省南部一所学术中心的初级保健诊所和患者研究人员。
参与者：对曾参与过先前 PaCER 研究且在过去任何时候每月有多数日子经历过膝盖疼痛的家庭医生（n=4；75%为女性）和 KOA 患者（n=5；60%为女性）进行有针对性的抽样。
结果：医生和患者对 KOA 的看法截然不同。患者参与者表示，KOA 严重影响了他们的生活和生活方式，他们希望自己的膝盖疼痛与其他健康问题一样受到重视。相比之下，医生一致将 KOA 视为相对较小的健康问题，尽管他们仍然认为 KOA 是一种会引起疼痛且经常限制患者活动的疾病。因此，医生并没有将 KOA 视为需要积极和积极管理的疾病。医生和患者对 KOA 的概念化及其治疗之间的差距延伸到了自我管理的应用程序。虽然患者对该应用程序表示支持，但医生对其使用持怀疑态度，更关注问责制和患者资源。
结论：医生的心理模型与患者对 KOA 的实际体验和感知需求之间明显存在差异，这强调了在 KOA 的治疗和管理方面存在理解和沟通上的差距。因此，这项初步和形成性研究将为开发一款应用程序提供信息，该应用程序将作为患者和医生之间的沟通工具，使患者和医生能够根据患者的观点和需求就可修改的自我管理选项进行讨论。
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