A mixed-methods study of patient and healthcare professional perceptions of care pathways for knee osteoarthritis

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.