Patient Perceptions of Access to Care and Referrals to Specialists

15 Oct
2009

Referrals to Specialists

By 2020, the estimated number of people in the United States suffering from arthritis in general will increase by 50%} By 2050, approximately 60 million Americans will suffer from arthritis at an estimated annual societal cost of $65 billion. The pain and dysfunction caused by osteoarthritis (OA) of the hip and knee is a leading cause of disability in the United States. As the U.S. population ages, the burden of clinically significant knee and hip OA will increase significantly. Knee and hip OA is one of the most common types of arthritis encountered in clinical practice, and the disability attributed to the pain of lower-extremity arthritis is disproportionately higher in older and minority populations.

There is currently no definitive cure for OA. However, joint replacement as a treatment for end-stage knee and hip OA has been proven to restore previously lost function and, thus, improve quality of life for patients while being cost-effective. Yet, there are marked racial and ethnic disparities in the utilization of this effective treatment option. For instance, African-American patients are reported to be two-to-five times less likely than whites to undergo knee and hip joint replacement. Similarly, Hispanic patients have been reported to underutilize hip replacement. These racial/ethnic gaps in the utilization of knee and hip replacement for OA are believed to be increasing. Skinner and colleagues recently reported that Hispan-ics and non-Hispanic blacks received knee arthroplasty at rates significantly lower than non-Hispanic whites; gender and geographic area also contributed to the observed differences in receipt of this service. Cialis Jelly

The reasons for racial/ethnic disparities in the utilization of knee and hip joint replacement are not known and may include bias or culture factors. They cannot be explained by racial/ethnic or demographic differences in the prevalence of knee and hip OA. Ibrahim and colleagues have examined potential patient-level factors that may play a role in this disparity. For instance, Ibrahim and colleagues found that patient familiarity with knee and hip replacement, self-reported quality of life, and beliefs concerning postre-placement outcomes vary between African-American and white patients with moderate-to-severe knee and hip OA. However, little is known about nonpatient factors, such as access to care, provider and system of care, which may contribute to this disparity. cheap female viagra

We examined patient perceptions in a sample of older male individuals with moderate-to-severe knee and hip OA, potential candidates for joint replacement who were receiving care in a VA medical center. Specifically, we examined whether patients’ perceptions regarding healthcare access; satisfaction with care; and other non-patient factors, such as referrals to specialist care (orthopedics and rheumatology), vary by race/ethnicity.

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