Abstract
To determine patients', healthcare providers', and insurance company employees' preferences for knee and hip osteoarthritis (KHOA) care. In a discrete choice experiment, patients with KHOA or a joint replacement, healthcare providers, and insurance company employees were repetitively asked to choose between KHOA care alternatives that differed in six attributes: waiting times, out of pocket costs, travel distance, involved healthcare providers, duration of consultation, and access to specialist equipment. A (panel latent class) conditional logit model was used to determine preference heterogeneity and relative importance of the attributes. Patients (n=648) and healthcare providers (n=76) valued low out of pocket costs most, while insurance company employees (n=150) found a joint consultation by general practitioner (GP) and orthopaedist most important. Patients found the duration of consultation less important than healthcare providers and insurance company employees did. Patients without a joint replacement were likely to prefer healthcare with low out of pocket costs. Patients with a joint replacement and/or low disease-specific quality of life were likely to prefer healthcare from an orthopaedist. Patients who already received healthcare for knee/hip problems were likely to prefer a joint consultation by GP and orthopaedist, and direct access to specialist equipment. Patients, healthcare providers, and insurance company employees highly prefer a joint consultation by GP and orthopaedist with low out of pocket costs. Within patients, there is substantial preference heterogeneity. These results can be used by policy makers and healthcare providers to choose the most optimal combination of KHOA care aligned to patients' preferences.
Highlights
Osteoarthritis is one of the most prevalent chronic diseases, affecting 10% of the people over 60 years[1]
A total of 49.4% was included for having knee and hip osteoarthritis (KHOA) according to NICEguidelines only, 19.5% for a KHOA diagnosis by a clinician only, and 31.1% for both criteria
This study showed that patients who received healthcare for their knee or hip complaints previously and/or low disease-specific QoL and/or a joint replacement strongly preferred an orthopaedist during consultation
Summary
Osteoarthritis is one of the most prevalent chronic diseases, affecting 10% of the people over 60 years[1]. The knee and hip are the most commonly affected joints[2,3]. Treatment for knee and hip osteoarthritis (KHOA) focuses on controlling symptoms and improving function. Guidelines advocate pro-active, non-surgical treatment for KHOA, which can be provided in primary care. Patients who do not respond sufficiently to non-surgical treatment are referred to secondary care for surgical treatment4e6. Despite the wide range of treatment options, not every patient receives healthcare as they should according to the guidelines7e9. Many patients who are referred to secondary care do not need surgical treatment
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