From “surgical gatekeepers” to “patient navigators”

Background: While total joint replacement (TJR) is reserved for end-stage osteoarthritis (OA), a greater proportion of OA sufferers require nonsurgical treatment. Given the importance of primary healthcare physicians (PHCPs) in managing patients with OA, we surveyed local PHCPs to ascertain their perceptions and practice patterns regarding hip and knee OA management. Methods: A PHCP survey was developed to determine OA management practices within our region. Responses were analyzed using descriptive statistics. Response variance by practice duration (<15 yr compared with ≥15 yr) was explored. Results: A total of 265 (34%) PHCP surveys were received. PHCPs in practice fewer than 15 yr had a significantly greater proportion of patients with hip and knee OA than those in practice for longer than 15 yr (22% compared with 17%, P<0.0001). PHCPs agreed that radiographs are crucial in the decision for specialist referral (7/10), placing a higher value or utility on nonweightbearing radiographs for a knee OA diagnosis (87%). Mean comfort with discussing TJR indications and contraindications was 6/10 and was slightly higher than discussing postoperative-TJR course (5.7/10). Top treatments were weight loss, low-impact exercise, and oral nonsteroidal antiinflammatory drugs, with PHCPs in practice for fewer than 15 yr assigning higher value or utility to more holistic treatments. Conclusions: There is discordance in the conservative management of hip and knee OA, variability in nonsurgical management comfort level, and a knowledge gap in value and utility of plain radiographs within OA management algorithms among PHCPS. While younger PHCPs are in favor of earlier intervention and practice a more holistic symptom management approach, senior PHCPs stressed greater importance of traditional treatment. With the role of the PHCP shifting from surgical gatekeeper to patient navigator, future efforts aimed at helping facilitate this role are needed.