Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis.

PURPOSE: To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. MATERIALS AND METHOD: We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. RESULTS: Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. CONCLUSION: Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care.IMPLICATIONS FOR REHABILITATIONThe provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice.Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system.Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions.

Wait times, resource use and health-related quality of life across the continuum of care for patients referred for total knee replacement surgery.

Background: The escalating socioeconomic burden of knee osteoarthritis (OA) underscores the need for innovative strategies to reduce wait times for total knee arthroplasty (TKA). The purpose of this study was to evaluate resource use, costs and health-related quality of life (HRQoL) across the continuum of care for patients with knee OA. Methods: This was a prospective study of 383 patients recruited from a high-volume teaching hospital at different stages of care (referral, consultation and presurgery). Outcomes included health care resource use; costs captured from the health care payer, private sector and societal perspectives; HRQoL measured using the Western Ontario and McMaster Universities Osteoarthritis Index, the 12-Item Short Form Health Survey, and EuroQoL 5-Dimension 5-Level tool; wait times; and the proportion of referrals deemed suitable candidates for surgery. Results: The most commonly used conservative treatments were pharmacotherapy, exercise and lifestyle modification. Forty percent of patients referred for TKA were deemed not to be suitable candidates for surgery. The greatest proportion of costs was borne by the patient or private insurer; a small proportion was borne by the public payer. Across all stages of care, more than 60% of the total costs was attributed to productivity losses. HRQoL remained relatively stable throughout the waiting period (mean wait time from referral to TKA 13.2 mo) but improved postoperatively. Conclusion: The suboptimal primary care management of knee OA calls for the development of innovative models of care. This study may provide valuable guidance on the design and implementation of a new online educational platform to improve referral efficiency and expedite wait times for TKA.

Contexte: Le fardeau socioéconomique croissant de l'arthrose du genou rappelle que nous avons besoin de stratégies novatrices afin de réduire les temps d'attente pour l'arthroplastie totale du genou (ATG). Le but de cette étude est d'évaluer l'utilisation des ressources, les coûts et la qualité de vie liée à la santé (QVLS) dans tout le continuum des soins pour les patients souffrant d'arthrose du genou. Méthodes: Cette étude prospective a porté sur 383 patients recrutés dans un établissement d'enseignement fort achalandé, qui en étaient à différentes étapes du continuum de soins (demande de consultation, consultation et préchirurgie). Les paramètres incluaient l'utilisation des ressources en santé, les coûts du point de vue sociétal et des régimes d'assurance maladie publics et privés, la QVLS mesurée au moyen de l'indice WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), du questionnaire Short Form Health Survey en 12 points et de l'outil EuroQoL appliqué à 5 dimensions et à 5 niveaux, les temps d'attente, et la proportion de demandes de consultation concernant des patients considérés comme de bons candidats à la chirurgie. Résultats: Les traitements conservateurs les plus utilisés étaient la pharmacothérapie, l'exercice et les modifications à l'hygiène de vie. Quarante pour cent des patients adressés en consultation pour ATG ont été considérés comme de bons candidats à la chirurgie. La plus grande part des coûts a été assumée par le patient ou un assureur privé; une faible part des coûts a été assumée par le régime public. À toutes les étapes du continuum, plus de 60 % des coûts totaux ont été attribués à des pertes de productivité. La QVLS est demeurée relativement stable tout au long de la période d'attente (temps d'attente moyen entre la consultation et l'ATG, 13,2 mois) mais s'est améliorée après la chirurgie. Conclusion: La prise en charge sous-optimale de l'arthrose du genou en soins primaires rappelle qu'il est nécessaire d'établir des modèles de soins novateurs. Cette étude pourrait faciliter la mise au point et l'application d'une nouvelle plateforme éducative en ligne pour améliorer l'efficience des demandes de consultation et abréger les temps d'attente pour l'ATG.

Trends in knee arthroscopy utilization: a gap in knowledge translation.

PURPOSE: To evaluate the longitudinal trends in knee arthroscopy utilization in relation to published negative randomized controlled trials, focusing on annual rates, patient demographics and associated 30-day post-operative complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify arthroscopy cases between 2006 and 2016. 30-day post-operative complications were identified, and potential risk factors analysed using univariate and multivariate analyses. RESULTS: 68,346 patients underwent knee arthroscopy, of which 47,446 (69.5%) represented partial meniscectomies. The annual procedural rate, as a proportion of all reported cases, increased significantly from 2006 (0.3%) to 2016 (1.6%; p < 0.001), along with a significant increase in average patient age (44.3 ± 15.5 to 48.4 ± 14.5; p < 0.001). Specifically focusing on the meniscectomy cohort, average patient age significantly increased from 47.9 ± 15.1 to 50.7 ± 13.5 (p = 0.001). The overall incidence of complications was 2.0% (n = 1333), with major complications in 0.9% (n = 639) and minor complications in 1.0% (n = 701). Common complications included a return to the operating room (0.5%), deep vein thrombosis/thrombophlebitis (0.4%), and superficial infection (0.2%). Operating time > 90 min, diabetes, steroid use, ASA class 2+, and dialysis-dependency were the predictors of overall complication rates. CONCLUSION: Despite the publication of negative trials and new clinical practice guidelines, knee arthroscopy utilization and average patient age continue to increase. Given the high utilization, even low adverse event rates equate to substantial numbers of patients with minor and major complications. The NSQIP data show a gap in knowledge translation to clinical practice and highlight the need for improved clinical guidelines. LEVEL OF EVIDENCE: Cohort study; Level III.

Optimizing outpatient total hip arthroplasty: perspectives of key stakeholders.

BACKGROUND: Advances in surgical techniques combined with multimodal analgesia and early rehabilitation have potentiated early mobilization in patients undergoing total hip arthroplasty (THA). Given an increasing push from patients to accelerate recovery and health care budgetary limitations, there has been growing interest in the implementation of outpatient THA in selected patients. Understanding the patient and primary caregiver experience of outpatient THA is important to optimize care. We aimed to gain insight into patient and caregiver perspectives regarding the perceived advantages and disadvantages of same-day discharge to identify areas of care that can be improved. METHOD: Using a qualitative descriptive approach, we conducted in-depth semistructured interviews with patient-primary caregiver dyads who experienced same-day discharge or standard care after primary THA with the direct anterior approach in 2016-2017. Two members of the research team coded the data independently, implementing a thematic and content analysis. RESULTS: Twenty-eight participants (16 same-day discharge, 12 standard care) were included. Both groups experienced high levels of satisfaction with their care pathway. Concerns and challenges identified in both groups pertained to mobility, pain, self-care and caregiver support. Challenges and concerns unique to same-day discharge were identified regarding expectations for recovery, medications and their impact on mobility, the timing of postoperative education and the availability of formal care. CONCLUSION: Outpatient THA can be implemented with high patient and caregiver satisfaction. Preoperative education, clarification of recovery processes and expectations, and proactively addressing concerns related to caregiving are important.

CONTEXTE: Les progrès des techniques chirurgicales, alliés à l'analgésie multimodale et à la réadaptation hâtive, ont potentialisé la mobilisation précoce des patients soumis à une intervention pour prothèse totale de la hanche (PTH). Compte tenu de la pression croissante venant des patients pour accélérer leur rétablissement et des contraintes budgétaires en santé, on s'intéresse de plus en plus à la PTH effectuée en externe chez certains patients. Pour optimiser les soins, il est important de comprendre l'expérience des patients et de leurs proches aidants relativement à la PTH effectuée en externe. Nous avons voulu cerner les points de vue des patients et des proches aidants au sujet des avantages et inconvénients perçus du congé le jour même, afin de déterminer quels éléments des soins gagneraient à être améliorés. MÉTHODES: À l'aide d'une approche qualitative descriptive, nous avons procédé à des entrevues semi-structurées approfondies avec des paires patients-proches aidants à qui on a offert soit le congé le jour même, soit les soins standards après une PTH primaire par approche antérieure directe en 2016-2017. Deux membres de l'équipe de recherche ont codé les données indépendamment, en procédant à une analyse par thèmes et par contenu. RÉSULTATS: Vingt-huit participants (16 ayant reçu leur congé le jour même et 12 soumis aux soins standards) ont été inclus. Les 2 groupes ont exprimé un degré élevé de satisfaction à l'endroit du déroulement de leurs soins. Les problèmes et les difficultés identifiés dans les 2 groupes concernaient la mobilité, la douleur, les soins personnels et le soutien aux proches aidants. Les difficultés ou problèmes particuliers aux cas de congé le jour même ont été associés aux attentes concernant le rétablissement, les médicaments et leur impact sur la mobilité, le moment de l'enseignement postopératoire et la disponibilité des soins standards. CONCLUSION: La PTH en externe peut être offerte et générer beaucoup de satisfaction chez les patients et leurs aidants. Il est important d'offrir un enseignement préopératoire, de clarifier le processus de rétablissement et les attentes et de répondre de manière proactive aux préoccupations exprimées relativement aux soins.