La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
Musculoskeletal Care. 2022 Dec;20(4):860-872. doi: 10.1002/msc.1638. Epub 2022 Apr 11.
Hip and knee osteoarthritis guidelines internationally provide consistent first-line care recommendations. However, uptake of these recommendations remains suboptimal. This qualitative study explores factors influencing guideline-based care from the perspectives of physiotherapists working in specialised osteoarthritis services across different models of care.
Nineteen semi-structured interviews were conducted with physiotherapists working in specialist osteoarthritis services across three different Australian models of care (OsteoArthritis Hip and Knee Service n = 10; OsteoArthritis Chronic Care Programme n = 4; Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services n = 5). Interviews were audio recorded and transcribed verbatim. Data were coded and analysed inductively using thematic analysis.
The overarching theme to emerge was that accessing first-line osteoarthritis care is complex and difficult, regardless of model of care. Subthemes indicated that: (i) services are either unavailable or inadequately funded, (ii) referral pathways are labyrinthine and lengthy, (iii) patients and other health professionals often believe that surgery is the only/best option and (iv) managing patient co-morbidities is challenging.
Physiotherapists working in specialised osteoarthritis services perceive multiple and complex factors influencing adherence to first-line care. Barriers occur at various levels in all models of care, including patient and health professional beliefs, health service, and system levels. These results suggest improving healthcare for people with osteoarthritis requires urgent system reform.
国际上的髋和膝关节骨关节炎指南提供了一致的一线治疗建议。然而，这些建议的采纳情况仍不理想。本定性研究从不同护理模式下专门的骨关节炎服务中工作的物理治疗师的角度探讨了影响基于指南的护理的因素。
对在澳大利亚三种不同护理模式（髋关节和膝关节骨关节炎服务 n=10；骨关节炎慢性护理计划 n=4；骨科物理治疗筛查诊所和多学科服务 n=5）中工作的物理治疗师进行了 19 次半结构化访谈。访谈以录音和逐字记录的方式进行。使用主题分析对数据进行编码和归纳分析。
出现的首要主题是，无论护理模式如何，获得一线骨关节炎护理都很复杂和困难。子主题表明：（i）服务要么不可用，要么资金不足，（ii）转诊途径复杂且漫长，（iii）患者和其他卫生专业人员通常认为手术是唯一/最佳选择，以及（iv）管理患者合并症具有挑战性。
在专门的骨关节炎服务中工作的物理治疗师认为，有多个复杂因素影响对一线护理的遵守。障碍发生在所有护理模式的各个层面，包括患者和卫生专业人员的信念、卫生服务和系统层面。这些结果表明，改善骨关节炎患者的医疗服务需要紧急进行系统改革。
