Mirt Pika Krištof, Erjavec Karmen, Krsnik Sabina, Kotnik Petra, Hussein Mohsen
General Hospital Novo mesto, Šmihelska cesta 1, Novo mesto, 8000, Slovenia.
University of Novo mesto, Na Loko 2, Novo mesto, 8000, Slovenia.
BMC Prim Care. 2024 Dec 21;25(1):435. doi: 10.1186/s12875-024-02690-0.
This study aimed to address research gap concerning the perception of the care pathway for knee osteoarthritis (KOA) patients, focusing on both the patient and health professional perspectives in countries with inefficient health systems, such as Slovenia, by examining patient satisfaction with conservative treatment, assessing the perceptions of both patients and health professionals regarding the latter's involvement, and justifying the chosen KOA treatment approaches.
A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews with KOA patients (n = 82) and healthcare professionals (n = 68).
The care pathway for conservative KOA treatment in Slovenia begins with general practitioners (GPs), who conduct initial examinations, prescribe analgesics, and refer patients to radiologists and orthopaedic surgeons. GPs received high satisfaction ratings (μ = 4.32). Orthopaedic surgeons, who confirm diagnoses and create treatment plans involving physiotherapy, medication, or joint injections, also received high satisfaction scores (μ = 4.47), despite long waiting times. Consultations with radiologists, mentioned less frequently, again received high satisfaction scores (μ = 4.67). Physiotherapists, consulted later, received high satisfaction scores (μ = 4.16) but long waiting times resurfaced. Referrals to rheumatologists occur for systemic diseases or ineffective conservative treatments. Psychologists, occupational therapists, and dieticians are rarely consulted, indicating limited integration into the treatment pathway. A comparison of health professionals' involvement showed that health professionals consider GP involvement less necessary (μ = 2.47) than patients do (μ = 2.82, p = 0.015). The same applies to radiologists (μ = 2.47 vs. μ = 2.87, p = 0.004), reflecting different views on diagnostic imaging. Our qualitative investigation revealed that, due to long waiting times, an alternative care pathway is developing with orthopaedic surgeons as the initial point of contact, bypassing GPs, and highlighted that patients and healthcare professionals differently perceive the latter's treatment roles.
The current conservative KOA care pathway lacks initial lifestyle change advice from the GP, referrals for conservative treatments, and a multidisciplinary team engaged in regular treatment monitoring and adjustment. Our mixed-methods research approach highlighted significant differences in perceptions of the treatment process and the roles of health professionals; the knowledge supplied of those differences should support experts and policymakers to optimise care pathways in Slovenia.
本研究旨在填补关于膝关节骨关节炎（KOA）患者护理路径认知方面的研究空白，通过调查患者对保守治疗的满意度、评估患者和医护人员对医护人员参与情况的看法，并为所选的KOA治疗方法提供依据，重点关注斯洛文尼亚等医疗系统效率低下国家的患者和医护人员视角。
采用混合方法，将对KOA患者（n = 82）和医疗专业人员（n = 68）的定量调查与定性访谈相结合。
斯洛文尼亚保守治疗KOA的护理路径始于全科医生（GP），他们进行初步检查、开镇痛药，并将患者转诊给放射科医生和骨科医生。全科医生获得了较高的满意度评分（μ = 4.32）。骨科医生负责确诊并制定包括物理治疗、药物治疗或关节注射的治疗计划，尽管等待时间较长，但也获得了较高的满意度评分（μ = 4.47）。较少被提及的与放射科医生的会诊也获得了较高的满意度评分（μ = 4.67）。稍后咨询的物理治疗师获得了较高的满意度评分（μ = 4.16），但等待时间问题再次出现。因全身性疾病或保守治疗无效而转诊给风湿病学家。很少咨询心理学家、职业治疗师和营养师，这表明他们在治疗路径中的整合有限。对医护人员参与情况的比较表明，医护人员认为全科医生的参与必要性低于患者（μ = 2.47对μ = 2.82，p = 0.015）。放射科医生的情况也是如此（μ = 2.47对μ = 2.87，p = 0.004），这反映了对诊断成像的不同看法。我们的定性调查显示，由于等待时间长，正在形成一种以骨科医生为初始接触点、绕过全科医生的替代护理路径，并强调患者和医护人员对后者治疗角色的认知不同。
目前保守治疗KOA的护理路径缺乏全科医生提供的初始生活方式改变建议、保守治疗的转诊，以及一个参与定期治疗监测和调整的多学科团队。我们的混合方法研究方法突出了对治疗过程和医护人员角色认知的显著差异；提供的这些差异知识应有助于专家和政策制定者优化斯洛文尼亚的护理路径。
