The Experts below are selected from a list of 60 Experts worldwide ranked by ideXlab platform
Belene Podmore - One of the best experts on this subject based on the ideXlab platform.
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comorbidities and the referral pathway to access joint replacement surgery an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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p51 comorbidities and the clinical pathway to access joint replacement surgery an exploratory qualitative study
Journal of Epidemiology and Community Health, 2018Co-Authors: Belene Podmore, Andrew Hutchings, John Robson, Sujith Konan, Jan Van Der Meulen, M A Durand, Rebecca LynchAbstract:Background Hip and knee replacement surgery is one of the most common and effective surgical procedures. The rise in multi-morbidity world-wide is leading to increasing numbers of patients with comorbid conditions undergoing joint replacement surgery. Financially stretched commissioners of health care services in the English National Health Service (NHS) are increasingly seeking to restrict access to elective surgery, including hip and knee replacement surgery despite a lack of evidence to support these decisions. It is important to get a better understanding of the referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative approach involving semi-structured interviews with eight orthopaedic surgeons, seven general practitioners (GPs), and five professionals working in intermediate musculoskeletal services (specific centres within the English NHS to support the referral process from primary to specialised care). Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement. Each professional group, however, concentrated on different aspects of the patients’ condition which appeared to affect how each group managed patients with comorbidities. GPs focused on the long-term impact that comorbidities have on the patients’ everyday life. Intermediate care professionals focused on the short-term impact of comorbidities on the patients’ likelihood of being selected for surgery. Orthopaedic surgeons focused on the short-term impact of comorbidities on the surgery itself. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the three groups believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusion At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. The current orthopaedic clinical pathway may be less suitable for patients with comorbidities.
Rebecca Lynch - One of the best experts on this subject based on the ideXlab platform.
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comorbidities and the referral pathway to access joint replacement surgery an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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p51 comorbidities and the clinical pathway to access joint replacement surgery an exploratory qualitative study
Journal of Epidemiology and Community Health, 2018Co-Authors: Belene Podmore, Andrew Hutchings, John Robson, Sujith Konan, Jan Van Der Meulen, M A Durand, Rebecca LynchAbstract:Background Hip and knee replacement surgery is one of the most common and effective surgical procedures. The rise in multi-morbidity world-wide is leading to increasing numbers of patients with comorbid conditions undergoing joint replacement surgery. Financially stretched commissioners of health care services in the English National Health Service (NHS) are increasingly seeking to restrict access to elective surgery, including hip and knee replacement surgery despite a lack of evidence to support these decisions. It is important to get a better understanding of the referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative approach involving semi-structured interviews with eight orthopaedic surgeons, seven general practitioners (GPs), and five professionals working in intermediate musculoskeletal services (specific centres within the English NHS to support the referral process from primary to specialised care). Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement. Each professional group, however, concentrated on different aspects of the patients’ condition which appeared to affect how each group managed patients with comorbidities. GPs focused on the long-term impact that comorbidities have on the patients’ everyday life. Intermediate care professionals focused on the short-term impact of comorbidities on the patients’ likelihood of being selected for surgery. Orthopaedic surgeons focused on the short-term impact of comorbidities on the surgery itself. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the three groups believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusion At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. The current orthopaedic clinical pathway may be less suitable for patients with comorbidities.
Jan Van Der Meulen - One of the best experts on this subject based on the ideXlab platform.
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comorbidities and the referral pathway to access joint replacement surgery an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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p51 comorbidities and the clinical pathway to access joint replacement surgery an exploratory qualitative study
Journal of Epidemiology and Community Health, 2018Co-Authors: Belene Podmore, Andrew Hutchings, John Robson, Sujith Konan, Jan Van Der Meulen, M A Durand, Rebecca LynchAbstract:Background Hip and knee replacement surgery is one of the most common and effective surgical procedures. The rise in multi-morbidity world-wide is leading to increasing numbers of patients with comorbid conditions undergoing joint replacement surgery. Financially stretched commissioners of health care services in the English National Health Service (NHS) are increasingly seeking to restrict access to elective surgery, including hip and knee replacement surgery despite a lack of evidence to support these decisions. It is important to get a better understanding of the referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative approach involving semi-structured interviews with eight orthopaedic surgeons, seven general practitioners (GPs), and five professionals working in intermediate musculoskeletal services (specific centres within the English NHS to support the referral process from primary to specialised care). Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement. Each professional group, however, concentrated on different aspects of the patients’ condition which appeared to affect how each group managed patients with comorbidities. GPs focused on the long-term impact that comorbidities have on the patients’ everyday life. Intermediate care professionals focused on the short-term impact of comorbidities on the patients’ likelihood of being selected for surgery. Orthopaedic surgeons focused on the short-term impact of comorbidities on the surgery itself. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the three groups believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusion At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. The current orthopaedic clinical pathway may be less suitable for patients with comorbidities.
Andrew Hutchings - One of the best experts on this subject based on the ideXlab platform.
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comorbidities and the referral pathway to access joint replacement surgery an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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p51 comorbidities and the clinical pathway to access joint replacement surgery an exploratory qualitative study
Journal of Epidemiology and Community Health, 2018Co-Authors: Belene Podmore, Andrew Hutchings, John Robson, Sujith Konan, Jan Van Der Meulen, M A Durand, Rebecca LynchAbstract:Background Hip and knee replacement surgery is one of the most common and effective surgical procedures. The rise in multi-morbidity world-wide is leading to increasing numbers of patients with comorbid conditions undergoing joint replacement surgery. Financially stretched commissioners of health care services in the English National Health Service (NHS) are increasingly seeking to restrict access to elective surgery, including hip and knee replacement surgery despite a lack of evidence to support these decisions. It is important to get a better understanding of the referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative approach involving semi-structured interviews with eight orthopaedic surgeons, seven general practitioners (GPs), and five professionals working in intermediate musculoskeletal services (specific centres within the English NHS to support the referral process from primary to specialised care). Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement. Each professional group, however, concentrated on different aspects of the patients’ condition which appeared to affect how each group managed patients with comorbidities. GPs focused on the long-term impact that comorbidities have on the patients’ everyday life. Intermediate care professionals focused on the short-term impact of comorbidities on the patients’ likelihood of being selected for surgery. Orthopaedic surgeons focused on the short-term impact of comorbidities on the surgery itself. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the three groups believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusion At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. The current orthopaedic clinical pathway may be less suitable for patients with comorbidities.
Sujith Konan - One of the best experts on this subject based on the ideXlab platform.
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comorbidities and the referral pathway to access joint replacement surgery an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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Comorbidities and the referral pathway to access joint replacement surgery: an exploratory qualitative study
BMC Health Services Research, 2018Co-Authors: Belene Podmore, Andrew Hutchings, Maryalison Durand, John Robson, Sujith Konan, Jan Van Der Meulen, Rebecca LynchAbstract:Background Variation in access to joint replacement surgery has been widely reported but less attention has been given to the impact of comorbidities on the patient journey to joint replacement surgery. There is a lack of consensus amongst healthcare professionals and commissioners about how patients with comorbidities should be referred or selected for joint replacement surgery. It is therefore important to understand the views of healthcare professionals on the management, referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative study involving semi-structured interviews with 20 healthcare professionals in England across the referral pathway to joint replacement surgery. They were asked to talk about their experiences of referring and selecting patients with comorbidities for joint replacement surgery. The interviews were audio-recorded and transcribed verbatim. Data analysis followed a thematic analysis approach based on the principles of grounded theory. Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement but was seen as a challenge to manage the patients’ journey across the referral pathway. Each professional group, concentrated on different aspects of the patients’ condition which appeared to affect how they managed patients with comorbidities. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the professionals believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusions At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. Further study is needed to explore the roles and responsibilities of professionals across the current orthopaedic referral pathway which may be less suitable for patients with comorbidities.
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p51 comorbidities and the clinical pathway to access joint replacement surgery an exploratory qualitative study
Journal of Epidemiology and Community Health, 2018Co-Authors: Belene Podmore, Andrew Hutchings, John Robson, Sujith Konan, Jan Van Der Meulen, M A Durand, Rebecca LynchAbstract:Background Hip and knee replacement surgery is one of the most common and effective surgical procedures. The rise in multi-morbidity world-wide is leading to increasing numbers of patients with comorbid conditions undergoing joint replacement surgery. Financially stretched commissioners of health care services in the English National Health Service (NHS) are increasingly seeking to restrict access to elective surgery, including hip and knee replacement surgery despite a lack of evidence to support these decisions. It is important to get a better understanding of the referral and selection of patients with comorbidities for joint replacement surgery. Methods An exploratory qualitative approach involving semi-structured interviews with eight orthopaedic surgeons, seven general practitioners (GPs), and five professionals working in intermediate musculoskeletal services (specific centres within the English NHS to support the referral process from primary to specialised care). Results In general, the presence of comorbidities was not seen as a Barrier to being referred or selected for joint replacement. Each professional group, however, concentrated on different aspects of the patients’ condition which appeared to affect how each group managed patients with comorbidities. GPs focused on the long-term impact that comorbidities have on the patients’ everyday life. Intermediate care professionals focused on the short-term impact of comorbidities on the patients’ likelihood of being selected for surgery. Orthopaedic surgeons focused on the short-term impact of comorbidities on the surgery itself. This implied there was a disagreement about roles and responsibilities in the management of patients with comorbidities. None of the three groups believed it was their responsibility to address comorbidities in preparation for surgery. This disagreement was identified as a reason why some patients seem to ‘get lost’ in the referral system when they were considered to be unprepared for surgery. Patients were then potentially left to manage their own comorbidities before being reconsidered for joint replacement. Conclusion At the clinician-level, comorbidities were not perceived as a Barrier to accessing joint replacement surgery but at the pathway-level, it may create an Implicit Barrier such that patients with comorbidities may get ‘lost’ to the system. The current orthopaedic clinical pathway may be less suitable for patients with comorbidities.
