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探索骨关节炎治疗的迷宫:一项质性研究,探究澳大利亚塔斯马尼亚州骨关节炎患者的经历

Navigating the maze of osteoarthritis treatment: A qualitative study exploring the experience of individuals with osteoarthritis in Tasmania, Australia.

作者信息

Sutton Laura, Jose Kim, Hansen Emily, Laslett Laura, Makin Jennifer, Winzenberg Tania, Balogun Saliu, Aitken Dawn

机构信息

Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia.

School of Social Sciences, University of Tasmania, Tasmania, Australia.

出版信息

Musculoskeletal Care. 2023 Mar;21(1):264-271. doi: 10.1002/msc.1700. Epub 2022 Sep 12.

DOI:10.1002/msc.1700
PMID:36097647
Abstract

OBJECTIVE

Using a qualitative design this study aimed to (1) explore the experience of people living with osteoarthritis (OA), (2) gain an understanding of their navigation of the health system and, (3) explore their opinions on the role of exercise and joint replacement surgery for the management of OA.

METHODS

Purposive sampling was used to recruit 26 participants with knee OA, aged 45 years and over, from Tasmania, Australia. Semi-structured interviews were audio-recorded, transcribed, coded, and thematically analysed to document participant understanding and experience of OA and their opinions on the role of exercise and surgery in managing OA.

RESULTS

Of the 26 participants, 80% (n = 21) were female with a mean age of 66 years. The main theme identified was that individuals with knee OA were navigating a maze of OA treatments. Three related subthemes were that participants: (i) perceived their general practitioner did not have an ongoing role in their OA care, (ii) self-directed their management and, (iii) sampled from a 'smorgasbord' of treatment options, including low-value care options. Two other major themes were: the role of exercise for OA management, and surgery as a last resort.

CONCLUSION

Our findings suggest that OA patients may not be choosing consistent, high-value care for their OA. This highlights the importance of an evidence-based multi-disciplinary approach to guide patients to self-manage their OA and support their navigation of the health system. Reducing emphasis on the pathway to surgery and streamlining access to conservative management strategies may assist people to receive high-value care.

摘要

目的

本研究采用定性设计,旨在(1)探索骨关节炎(OA)患者的经历,(2)了解他们在医疗系统中的就医过程,以及(3)探讨他们对运动和关节置换手术在OA管理中作用的看法。

方法

采用目的抽样法,从澳大利亚塔斯马尼亚招募了26名年龄在45岁及以上的膝骨关节炎患者。对访谈进行录音、转录、编码和主题分析,以记录参与者对OA的理解和经历,以及他们对运动和手术在OA管理中作用的看法。

结果

26名参与者中,80%(n = 21)为女性,平均年龄66岁。确定的主要主题是膝骨关节炎患者在OA治疗的迷宫中摸索前行。三个相关的子主题是:(i)参与者认为他们的全科医生在其OA护理中没有持续发挥作用,(ii)他们自行管理,以及(iii)从一系列“自助餐式”治疗选项中进行选择,包括低价值护理选项。另外两个主要主题是:运动在OA管理中的作用,以及手术作为最后手段。

结论

我们的研究结果表明,OA患者可能没有为其OA选择一致的、高价值的护理。这凸显了采取循证多学科方法的重要性,以指导患者自我管理OA,并支持他们在医疗系统中的就医过程。减少对手术途径的重视并简化保守管理策略的获取途径,可能有助于人们获得高价值护理。

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