Yerke Hansen Payton, Macknofsky Brandon, Busheme Cara E, Fomunung Clyde K, Lavin Alessia C, Fernandez Carlos A, Sabesan Vani
Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA.
Department of Orthopaedics, JFK/University of Miami, Palm Beach, FL, USA.
Arthroplast Today. 2023 Jun 12;21:101143. doi: 10.1016/j.artd.2023.101143. eCollection 2023 Jun.
Rigorous training may lead to increased rates of knee osteoarthritis and arthroplasties in military service members. Given the large numbers of arthritis and the increasing need for total joint replacements, access to appropriate care can be difficult for this population based on insurance restrictions. The aim of this study was to evaluate access to total knee arthroplasty for TRICARE patients in contracted civilian medical facilities.
Orthopedic surgeons contracted to perform total knee replacements in the state of Florida were identified via TRICARE's website. Investigators used a secret shopper methodology with a standardized script to request an appointment for their family member for a total knee arthroplasty using either TRICARE Select or BlueCross preferred provider organization. The appointment acceptance rates, wait times, call duration, and accuracy of the physician listing were collected.
A total of 228 offices that perform total knee arthroplasties in Florida were successfully contacted. Overall, 43.1% of the clinics had an inaccurate online listing, and 207 (91%) were able to schedule an appointment with TRICARE, compared to 93% for BlueCross Blue Shield ( = .06). The average wait for TRICARE patients was 24 days and 18 days for BlueCross ( < .01). Call times for TRICARE patients averaged 7.2 minutes, compared to 5.2 minutes for BlueCross ( < .01).
TRICARE patients encountered longer waiting periods and inaccurate provider listings when accessing orthopedic care. Our results suggest a disparity in healthcare access for patients using TRICARE, which may result in negative health outcomes from receiving delayed care.
高强度训练可能会导致军人膝关节骨关节炎和关节置换手术的发生率增加。鉴于关节炎患者数量众多以及全关节置换需求不断上升，基于保险限制，这一人群获得适当治疗可能会面临困难。本研究的目的是评估在签约的民用医疗设施中，TRICARE患者接受全膝关节置换手术的可及性。
通过TRICARE的网站确定在佛罗里达州签约进行全膝关节置换手术的骨科医生。研究人员采用秘密购物者方法，使用标准化脚本为其家庭成员预约全膝关节置换手术，使用TRICARE Select或蓝十字优选医疗机构。收集预约接受率、等待时间、通话时长以及医生名单的准确性。
佛罗里达州共有228家进行全膝关节置换手术的诊所被成功联系。总体而言，43.1%的诊所在线名单不准确，207家（91%）能够为TRICARE安排预约，而蓝十字蓝盾的这一比例为93%（P = 0.06）。TRICARE患者的平均等待时间为24天，蓝十字患者为18天（P < 0.01）。TRICARE患者的通话时间平均为7.2分钟，而蓝十字患者为5.2分钟（P < 0.01）。
TRICARE患者在获得骨科护理时遇到更长的等待时间和不准确的医疗机构名单。我们的结果表明，使用TRICARE的患者在医疗可及性方面存在差异，这可能导致因延迟治疗而产生负面健康结果。
