Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.
Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
BMC Health Serv Res. 2021 Sep 11;21(1):952. doi: 10.1186/s12913-021-06965-5.
The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients' decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients' reasons for not accepting a consultation with a surgeon.
This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire.
Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = - 0.02, 95% CI: - 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = - 0.05, 95% CI: - 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery.
There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.
许多国家已经引入了高级实践物理治疗师的角色，以改善髋膝关节关节炎患者的医疗服务可及性。传统的医疗模式显示出性别偏见，女性接受手术推荐的比例低于男性。本研究旨在探讨在与高级实践提供者的临床接触中，患者性别是否会影响医疗服务的可及性。我们的目标是：（1）确定在提供手术咨询的临床决策中是否存在性别差异；（2）确定在提供手术咨询的患者中，是否存在性别差异；（3）描述患者拒绝手术咨询的原因。
这是一项对 815 例因髋膝关节关节炎就诊于三级医疗中心并接受骨科医生转诊的患者的前瞻性研究。我们进行了多次逻辑回归分析，以调整严重程度来解决第一个目标，并进行了简单逻辑回归分析来回答第二个目标。通过问卷调查获得拒绝手术咨询的原因。
815 例患者（511 例女性，304 例男性）符合研究纳入标准。男性和女性被转诊到外科医生的概率没有差异（调整严重程度后的差异= -0.02，95%置信区间：-0.07，0.02）。男性和女性对转诊的接受程度也没有差异（差异= -0.05，95%置信区间：-0.09，0.00）。在拒绝手术咨询的 14 个原因中，有 5 个原因表明女性比男性更倾向于非手术治疗，并对手术存在恐惧/担忧，这表明存在性别差异。
在利用高级实践骨科提供者进行分诊的医疗模式中，没有强有力的证据表明男性和女性接受手术咨询的比例存在差异。本研究进一步证明，在卫生人力资源有限的情况下，适当培训的替代提供者在减少等待时间和增加护理价值方面发挥作用的护理模式是可行的策略。在最近因 COVID-19 大流行而加剧的骨科护理积压的情况下，这种护理模式是一种可行的策略，可以帮助管理积压的骨科护理。
