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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
Bélène Podmore1,2, Andrew Hutchings3,4, Mary-Alison Durand3
1Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. belene.podmore@lshtm.ac.uk.
BMC Health Services Research
|October 5, 2018
Summary
Comorbidities do not prevent joint replacement surgery access but can create system navigation challenges for patients. Healthcare professionals need clearer roles to manage these patients effectively through the referral pathway.
Area of Science:
- Orthopaedic Surgery
- Health Services Research
- Patient Pathway Management
Background:
- Access to joint replacement surgery varies, with limited focus on how comorbidities impact the patient journey.
- Healthcare professionals and commissioners lack consensus on managing, referring, and selecting patients with comorbidities for joint replacement.
- Understanding healthcare professionals' views on managing patients with comorbidities is crucial for optimizing the joint replacement pathway.
Purpose of the Study:
- To explore healthcare professionals' perspectives on the management, referral, and selection of patients with comorbidities for joint replacement surgery.
- To identify challenges and potential solutions within the existing referral pathway for patients with comorbidities.
Main Methods:
- An exploratory qualitative study was conducted using semi-structured interviews with 20 healthcare professionals in England.
- Participants were from various points along the referral pathway to joint replacement surgery.
- Thematic analysis, grounded in grounded theory principles, was applied to interview transcripts.
Main Results:
- Comorbidities were generally not viewed as a barrier to referral or selection but posed challenges to patient journey management.
- Disagreements among professional groups regarding roles and responsibilities in managing comorbidities were evident.
- A lack of perceived responsibility for addressing comorbidities pre-surgery led to some patients becoming 'lost' in the system.
Conclusions:
- While comorbidities are not a direct clinical barrier to joint replacement, they can create implicit pathway barriers, causing patients to be overlooked.
- Further research is required to define professional roles and responsibilities within orthopaedic referral pathways to better accommodate patients with comorbidities.
Keywords:
Access to surgeryComorbiditiesExperiences of healthcare professionalsIn-depth interviewsQualitative designMore Related Videos
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