Willingness and Access to Joint Replacement Among African American Patients With Knee Osteoarthritis: A Randomized, Controlled Intervention12. Issue 5 (23rd April 2013)

• Record Type: Journal Article
• Authors: Ibrahim, Said A.; Hanusa, Barbara H.; Hannon, Michael J.; Kresevic, Denise; Long, Judith; Kent Kwoh, C.
• Is Part Of: Arthritis and rheumatism. Volume 65:Issue 5(2013:May)
• Page Start: 1253
• Page End: 1261
• Publication Date: 2013-04-23
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; Arthritis -- Periodicals; Rheumatic Diseases -- Periodicals; Rhumatisme -- Périodiques; Arthrite -- Périodiques; 616.72
• DOI: 10.1002/art.37899
• Languages: English
• ISSNs: 0004-3591

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Objective</title> <p>African American patients are significantly less likely to undergo knee replacement for the management of knee osteoarthritis (OA). Racial difference in preference (willingness) has emerged as a key factor. This study was undertaken to examine the efficacy of a patient‐centered educational intervention on patient willingness and the likelihood of receiving a referral to an orthopedic clinic.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods</title> <p>A total of 639 African American patients with moderate‐to‐severe knee OA from 3 Veterans Affairs primary care clinics were enrolled in a randomized, controlled trial with a 2 × 2 factorial design. Patients were shown a knee OA decision‐aid video with or without brief counseling. The main outcome measures were change in patient willingness and receipt of a referral to an orthopedic clinic. Also assessed were whether patients discussed knee pain with their primary care provider or saw an orthopedic surgeon within 12 months of the intervention.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>At baseline, 67% of the participants were definitely/probably willing to consider knee replacement, with no difference among the groups. The intervention increased patient willingness (75%) in all groups at 1 month. For those who received the decision aid intervention alone, the gains were sustained for up to 3 months. By 12 months postintervention, patients who received any intervention were more likely to report engaging their provider in a discussion about knee pain (92% versus 85%), to receive a referral to an orthopedic surgeon (18% versus 13%), and for those with a referral, to attend an orthopedic consult (61% versus 50%).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusion</title> <p>An educational intervention significantly increased the willingness of African American patients to consider knee replacement. It also improved the likelihood of patient–provider discussion about knee pain and access to surgical evaluation.</p> </sec> </abstract>