Arthroplasty Follow-Up Pathways: A Qualitative Study of Current Practice and Healthcare Professionals' Attitudes and Motivations for Change.

Abstract

There is considerable diversity in arthroplasty follow-up pathways. This qualitative study aimed to understand healthcare professionals' practice and attitude to follow-up, their motivation for change and what evidence they considered before implementing new pathways. The main UKSAFE study enroled 38 centres providing revision procedures across the United Kingdom. A purposive sample of professional leads and service managers was identified from site contacts. Individual interviews were conducted by telephone, transcribed verbatim and analysed using a theoretical framework derived from current evidence and the data collected in our previous studies. We found that there had been a shift away from bringing patients back into the clinic for repeat follow-up assessments, but that this was not universal, and some centres had long-established care pathways that involved long-term follow-up. The way in which those services were provided might be different or have common features, but centres were likely to face common problems including large patient numbers and funding restraints. The reliability of newer prosthetics and surgical skill has influenced some changes by increasing confidence in a pathway which does not routinely provide long-term follow-up. Service commissioners also have a role to play in how follow-up care pathways are configured, but scrutiny of the ratio of new to follow-up appointments can put pressure on clinical staff to follow-up only patients with identified clinical need. Virtual clinics can provide a service to patients and use scarce resources efficiently, but NHS IT systems that would be needed to support more remote working, for example, telemedicine and plans to collect PROMS data online from patients to assist with monitoring were not advanced.