Survey On The Diagnosis And Treatment Of Patients With Knee Osteoarthritis In A Town Medical Community In Guangdong

Background and purposeKnee osteoarthritis is one of the most common clinical diseases.Its main symptom is knee pain.If the disease is not effectively controlled,it will eventually cause serious joint deformity and dysfunction.With the development of primary care service,at present,other than going to the hospital,a considerable number of knee osteoarthritis patients will go to primary care setting to see a doctor.This study investigates the status of attendance of patients with knee osteoarthritis to a County Integrated Healthcare Organization(CIHO)containing 19 community healthcare centers and the orthopedics outpatient clinic of a tertiary hospital 1 in a rural town in Guangdong province.This study investigates the diagnosis and treatment status of patients with knee osteoarthritis in CIHO,aiming to identify problems and provide reference for the diagnosis and treatment management and services of knee osteoarthritis.MethodsThis study was conducted using a mixed-method design containing quantitative and qualitative methods.The study samples were outpatient medical records of all patients with knee osteoarthritis who attended to the County Integrated Healthcare Organization(CIHO).In the qualitative part,a convenient sampling method was used to recruit 20 patients with knee osteoarthritis who have visited the community healthcare center for semi-structured interviews.Interview data were analyzed by the thematic framework analysis method.In the quantitative part,the patients’ general information,number of visits location,diagnosis,treatments and financial cost for the primary care services were collected by two researchers based on the inclusion and exclusion criteria.Data were analyzed employing descriptive analysis,independent sample t-test’ chi-square test and other methods.ResultsQuantitative results:A total of 8291 patients who met the criteria had their outpatient records analyzed.Among them,there were significantly more women(69.0%)than men(31.0%).Their age ranged from 30 to 100 years old and most of them were aged 50～80(84.5%).The average age of the patients was 62.26±12.70.The number of visits to the 19 communities was 4945,accounting for 59.6%of the total patients,and the number of visits to tertiary general hospitals was 3346,accounting for 40.4%of the total patients.It was found that the proportion of community visits by the elderly,women,and medical insurance patients was higher than that of the hospital.The proportion of patients who received two or more treatment methods at a single visit to the community was 75.60%,which was much higher than that to the hospital.A total of 2193(95.18%)patients received joint injection.The financial cost for the visits varies widely among the patients and this was related to a variety of factors.The whole organization did not pay adequate attention to patient education.Qualitative interview results:A total of five main themes were extracted,namely,"Patients’ awareness of the disease","The impact of the disease","The effect of treatment","Self-management of the disease",and "Experience of primary care visit".There were 11 sub-themes as "Current understanding of the disease","Ways of understanding of the disease","Physical functioning status","Emotional and psychological status","Social and family aspect","Treatment received","Perception of treatment effect","Current disease management strategies",and"Barriers/facilitating factors".Some concrete points summarized included that:the patient’s awareness of the disease was low;main ways of getting understanding of the disease include verbal description by doctors,online videos or articles and the views and opinions of surrounding people;the disease caused impact to a varying extent on the patients’ physical functions,emotional and psychological status and family and social aspects,but there was still lack of concern with the patients;patients received different treatment regimens and their expectations for treatment effect were too high;patients’ self-management of health was suboptimal,they were unclear about meaningfulness of self-management and how to do it effectively;and a patient’s experience of primary care visits can be affected by the physician,treatment outcomes,and the financial cost for the visit.ConclusionPatients with knee osteoarthritis in a town medical community generally tend to go to the community for treatment,which is mainly related to factors such as the convenience of the community and the relatively low cost of treatment.There is a problem of irregular diagnosis and treatment of knee osteoarthritis in the medical community,and there is still a lot of room for improvement in the diagnosis and treatment of knee osteoarthritis by community medical staff.Patients in the medical community have low awareness of knee osteoarthritis,do not pay high attention,do not have optimistic management status,and have poor medical experience.The medical community should increase the implementation rate of health education for medical staff,strengthen the close ties between communities and hospitals,and better implement graded diagnosis and treatment.