Patient gender does not influence referral to an orthopaedic surgeon by advanced practice orthopaedic providers: a prospective observational study in Canada.

BACKGROUND: The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients' decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients' reasons for not accepting a consultation with a surgeon. METHODS: This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire. RESULTS: Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = - 0.02, 95% CI: - 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = - 0.05, 95% CI: - 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery. CONCLUSIONS: There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.

Patients' perceptions of navigating "the system" for arthritis management: are they able to follow our recommendations?

PURPOSE: To understand whether a visit to a Hip/Knee Arthritis Assessment Centre (AC), where non-surgical candidates with arthritis are directed toward community resources and provided with a conservative treatment "prescription," contributes to patients' self-management and ability to access community resources. METHODS: A purposive sample of non-surgical patients was contacted 3-10 months after their AC visit. Three focus groups (n=20) and 20 semi-structured telephone interviews were conducted. Transcripts were systematically coded and analyzed using a qualitative descriptive research methodology. RESULTS: While participants generally reported that the AC visit improved self-management, analysis identified an emergent theme about the inadequacy of conservative management in general, subdivided into two sub-themes related to (1) limited access to high-quality, non-surgical treatment, such as physiotherapy and (2) health care providers' attitudes and approaches, which do not embrace chronic disease prevention and management. CONCLUSIONS: An AC visit contributes to arthritis self-management; however, the current health care system does not adequately support conservative treatment of chronic conditions. Treatment guidelines need to be tailored to the local health care context in which they are applied.

Objectif: Pour comprendre si une visite à un centre d'évaluation de l'arthrite de la hanche ou du genou, où des personnes qui ne sont pas candidates a grave; une intervention chirurgicale et ont de l'arthrite sont dirigées vers des ressources communautaires et reçoivent une « ordonnance ¼ portant sur un traitement de conservation, contribue à l'autoprise en charge par les patients et à leur capacité d'avoir accès aux ressources communautaires. Méthodes: On a communiqué, pendant 3 à 10 mois après leur visite au centre d'évaluation, avec un échantillon choisi à dessein de patients non candidats à une intervention chirurgicale. On a organisé trois groupes de discussion (n=20) et procédé à 20 entrevues téléphoniques semi structurées. Les comptes rendus ont été codés systématiquement et analysés au moyen d'une méthodologie de recherche descriptive qualitative. Résultats: Les participants ont signalé en général que les visites au centre d'évaluation amélioraient l'autoprise en charge, mais l'analyse a dégagé un thème émergent au sujet de l'insuffisance de la prise en charge conservatrice en général, subdivisé en deux sous-thèmes portant sur (1) l'accès limité à un traitement non chirurgical de grande qualité comme la physiothérapie et (2) les attitudes et les approches des fournisseurs de soins de santé qui n'adoptent pas la prévention et la prise en charge des maladies chroniques. Conclusions: Une visite à un centre d'évaluation contribue à l'autoprise en charge de l'arthrite, mais le système de santé actuel n'appuie pas adéquatement un traitement conservateur des problèmes chroniques. Il faut personnaliser les lignes directrices sur le traitement en fonction du contexte local des soins de santé où elles sont appliquées.