Perceived barriers in care for osteoarthritis

Abstract

Background/Purpose: To examine current arthritis treatments, barriers to treatment, and perceptions of health care decision making, especially preferences for patient-physician shared input. Method(s): A poll of people with arthritis was commissioned to gather data on patient perceptions with the purpose of improving information on the web site of The Arthritis Society of Canada. Respondents were asked for their disease diagnosis; impact of arthritis (e.g., pain, fatigue, disability with activities and social roles); challenges in getting care; and preferences for physician involvement in care decisions. Most questions were on a 1 to 5 scale ranging from 1 = no impact/importance to 5 = extreme impact/importance. Scores are reported as means or percentages unless otherwise stated. Result(s): Of the 1514 respondents, 558 reported only osteoarthritis (OA) and 1043 reported inflammatory arthritis (IA) (rheumatoid arthritis 499, psoriatic arthritis 235, ankylosing spondylitis 227, lupus 156). 69% were female; 69% were aged <65 years; 65% were married and 46% had completed post-secondary education. Mean disease duration was 12.9 years. There were few differences in findings by disease. Mean pain intensity was 6.0 (95% CI: 5.9-6.1) (1 to 10 scale). Mean number of joints (out of 13) was 4.3 (95% CI: 3.9-4.8), slightly less for OA (mean 3.8; 95% CI:3.6-4.0). The impact on daily activities was moderate with mean scores in the range of 2.6 to 4.0. The greatest impact was for intimate relations (4.0) and exercise (3.4). Respondents reported controlling pain, mobility and fatigue as being of high importance (mean score range 4.1-4.4). 52% reported taking medication orally; 15% by injection or infusion (mainly respondents with IA). Overall, 75% of respondents reported at least one challenge in getting treatment. The top 3 challenges were lack of affordable treatment (27.5%), long wait times for appointments (28.8%), and a perceived absence of beneficial treatments (e.g., "don't think anything can be done") (21.2%). Costs for treatments like physiotherapy and medication were noted in particular. Younger respondents tended to report more challenges. A sizable minority reported that nothing could be done for their arthritis (range 16.2 % to 26.3 % by disease). Respondents rated highly the importance of physician input when making decisions related to prescription medication (mean = 4.4) and surgery or physiotherapy (mean = 4.4). They expressed lower importance of seeking physician input on treatments like diet and exercise (mean = 3.7) and over-the counter-medications (mean = 3.8). Conclusion(s): Despite pain, a moderate impact on valued roles and activities, and a high importance of controlling a range of symptoms, most respondents reported challenges with getting treatment, including costs not covered by the health care system. Of concern is the perception of some that little was available in the way of efficacious care. There is a need for better patient information on what can be done to control arthritis and for interventions to minimize barriers in accessing appropriate treatments. Additional research on decision-making preferences would be beneficial in addressing a patient-centered approach to care.