Coetzee Marisa, Clifford Amanda M, Jordaan Jacobus D, Louw Quinette A
Division of Physiotherapy, Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Health Research Institute, Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland.
S Afr J Physiother. 2024 Jul 18;80(1):2027. doi: 10.4102/sajp.v80i1.2027. eCollection 2024.
Knee replacement surgery can significantly improve the quality of life of patients with severe knee osteoarthritis. Equitable access to knee replacement surgery is important to ensure that everyone, regardless of their socioeconomic status or geographical location, have fair and timely access.
The aim of our study was to (1) describe the health equity profile and quality of life of patients awaiting knee replacement at a single academic hospital in South Africa and to (2) describe the association between these health equity factors and the waiting time.
A cross-sectional survey and retrospective record review of patients awaiting knee replacement was conducted using the PROGRESS-Plus health equity framework. Chi-square statistics were used to calculate association between health equity factors and the waiting time.
Three-hundred and two ( = 302) patients (77% female; mean age 67 years) participated, of whom one in three patients waited 5 years or longer for surgery. Elderly patients (> 70 years) and patients from lower socio-economic background were less likely to have equitable access to surgery.
The current screening protocol for knee replacement surgery in the public health care sector does not provide equitable access to surgery. A more holistic screening approach alongside selective surgical prioritisation and rehabilitation could reduce the waiting list and facilitate equitable access to care.
Health equity factors such as socioeconomic status, age, and other patient characteristics such as life roles and employability should be taken into consideration when screening patients for elective knee replacement waiting lists.
膝关节置换手术可显著改善重度膝关节骨关节炎患者的生活质量。确保公平获得膝关节置换手术对于保证每个人，无论其社会经济地位或地理位置如何，都能公平、及时地获得治疗至关重要。
我们研究的目的是：（1）描述南非一家学术医院等待膝关节置换手术患者的健康公平状况和生活质量；（2）描述这些健康公平因素与等待时间之间的关联。
采用PROGRESS-Plus健康公平框架，对等待膝关节置换手术的患者进行横断面调查和回顾性记录审查。使用卡方统计量来计算健康公平因素与等待时间之间的关联。
302名患者（77%为女性；平均年龄67岁）参与了研究，其中三分之一的患者等待手术5年或更长时间。老年患者（>70岁）和社会经济背景较低的患者获得手术的公平性较低。
公共卫生保健部门目前的膝关节置换手术筛查方案未能提供公平的手术机会。一种更全面的筛查方法，同时结合选择性手术优先排序和康复措施，可减少等待名单并促进公平获得医疗服务。
在为择期膝关节置换等待名单上的患者进行筛查时，应考虑社会经济地位、年龄等健康公平因素以及生活角色和就业能力等其他患者特征。
