General practitioners experience multi-level barriers to implementing recommended care for hip and knee osteoarthritis: a qualitative study

Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study...

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Vydané v:BMC family practice Ročník 25; číslo 1; s. 423 - 11
Hlavní autori: Gibbs, Alison J., Barton, Christian J., Taylor, Nicholas F., Kemp, Joanne L., Wallis, Jason A., Manski-Nankervis, Jo-Anne, Ezzat, Allison M.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: London BioMed Central 19.12.2024
BioMed Central Ltd
Springer Nature B.V
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Abstract Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Methods Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Results Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Conclusions Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient’s beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
AbstractList Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Methods Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Results Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Conclusions Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient’s beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.BACKGROUNDGeneral practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.METHODSInterview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.RESULTSTwo interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.CONCLUSIONSDespite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Methods Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Results Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Conclusions Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient’s beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways. Methods Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model. Results Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler. Conclusions Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis. Keywords: Osteoarthritis management, General practitioner, Physiotherapy, Barriers, Qualitative
BackgroundGeneral practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.MethodsInterview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.ResultsTwo interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.ConclusionsDespite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient’s beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
ArticleNumber 423
Audience Academic
Author Ezzat, Allison M.
Barton, Christian J.
Kemp, Joanne L.
Wallis, Jason A.
Gibbs, Alison J.
Manski-Nankervis, Jo-Anne
Taylor, Nicholas F.
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  organization: La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Physiotherapy Department, Eastern Health, Box Hill Hospital
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  givenname: Christian J.
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  givenname: Nicholas F.
  surname: Taylor
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  givenname: Jo-Anne
  surname: Manski-Nankervis
  fullname: Manski-Nankervis, Jo-Anne
  organization: Primary Care and Family Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne
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  givenname: Allison M.
  surname: Ezzat
  fullname: Ezzat, Allison M.
  organization: La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Department of Physical Therapy, Faculty of Medicine, University of British Columbia
BackLink https://www.ncbi.nlm.nih.gov/pubmed/39702012$$D View this record in MEDLINE/PubMed
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Issue 1
Keywords Osteoarthritis management
Qualitative
General practitioner
Barriers
Physiotherapy
Language English
License 2024. The Author(s).
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Snippet Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led...
General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led...
Background General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led...
BackgroundGeneral practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led...
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StartPage 423
SubjectTerms Adult
Attitude of Health Personnel
Barriers
Care and treatment
Data collection
Family Medicine
Female
General Practice
General practitioner
General Practitioners - psychology
Humans
Influence
Interviews
Interviews as Topic
Knee
Knowledge
Male
Medical personnel
Medical referrals
Medical research
Medicine
Medicine & Public Health
Middle Aged
Narcotics
Orthopedics
Osteoarthritis
Osteoarthritis management
Osteoarthritis, Hip - therapy
Osteoarthritis, Knee - rehabilitation
Osteoarthritis, Knee - therapy
Out of pocket costs
Patient satisfaction
Physical therapy
Physical Therapy Modalities
Physicians (General practice)
Physiotherapy
Practice
Primary care
Primary Care Medicine
Professionals
Qualitative
Qualitative Research
Referral and Consultation
Surgeons
Surgery
Surveys
Therapeutics, Physiological
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Title General practitioners experience multi-level barriers to implementing recommended care for hip and knee osteoarthritis: a qualitative study
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