Patients' perceptions of joint replacement care in a changing healthcare system: a qualitative study
| dc.contributor.author | Webster, Fiona | |
| dc.contributor.author | Bremner, Samantha | |
| dc.contributor.author | Katz, Joel | |
| dc.contributor.author | Watt-Watson, Judy | |
| dc.contributor.author | Kennedy, Deborah | |
| dc.contributor.author | Sawhney, Mona | |
| dc.contributor.author | McCartney, Colin | |
| dc.date.accessioned | 2016-11-15T22:54:49Z | |
| dc.date.available | 2016-11-15T22:54:49Z | |
| dc.date.issued | 2014-02 | |
| dc.description.abstract | Background: Ontario has introduced strategies over the past decade to reduce wait times and length of stay and improve access to physiotherapy for orthopaedic and other patients. The aim of this study is to explore patients' experiences of joint replacement care during a significant system change in their care setting. Methods: A secondary analysis was done on semi-structured qualitative interviews that were conducted in 2009 with 12 individuals who had undergone at least two hip or knee replacements five years apart at a specialized orthopaedic centre in Ontario, Canada. Interview transcripts were coded and then organized into themes. Results: Although the original study aimed to capture participants' experiences with changes in anaesthetic technique between their first and second joint replacements, the participants described several unrelated differences in the care they received during this period. For example, participants had difficulty obtaining a referral to an orthopaedic surgeon from their family physician. They also noted that the hospital stay and in-hospital physiotherapy they received were shorter after the second joint replacement surgery. They identified guidance from physiotherapists as an important component of their recovery, but sometimes had difficulty arranging physiotherapy after hospital discharge following their most recent surgery. Conclusions: The changes described between the first and second joint replacements provide the participants' perspective on the impact of policy changes on wait times, reduced lengths of hospital stay and physiotherapy access. The impact of these policy changes, often made in an attempt to improve access to care, had an unintended and detrimental effect on participants' perceptions and experiences of the quality of care provided. Across Canada and internationally, most jurisdictions are striving to find ways to contain healthcare spending while also ensuring good access to high-quality care. Several evidence-based health policies have been introduced in Ontario with the goal of reducing wait times for surgery (Ontario MOHLTC 2008), reducing length of hospital stay (Kehlet and Wilmore 2008; Raphael et al. 2011) and lowering the system cost of physiotherapy (Dales 2005) for patients who require joint replacement. These provincial strategies aim to expedite patient care as a means of reducing costs to the healthcare system and providing greater access. Although patient outcomes are often cited as a driving force behind these initiatives, few studies have explored patients' experiences of these system changes, and no studies have examined patients' experiences of the impact of different strategies on a single procedure. We also question whether strategies whose primary aim is system cost reduction can be compatible with "patient-centred care" (Laine and Davidoff 1996) | en_US |
| dc.identifier.citation | Webster, F., Bremner, S., Katz, J., Watt-Watson, J., Kennedy, D., Sawhney, M., & McCartney, C.J. (2014). Patients' perceptions of joint replacement care in a changing healthcare system: a qualitative study. Healthcare Policy, 9(3), 55-66. doi:10.12927/hcpol.2014.23729 | |
| dc.identifier.issn | 1715-6572 | |
| dc.identifier.uri | http://hdl.handle.net/10315/32577 | |
| dc.language.iso | en_US | en_US |
| dc.publisher | Longwoods Publishing Corporation | en_US |
| dc.rights | Attribution-NonCommercial-NoDerivs 2.5 Canada | * |
| dc.rights.article | http://www.longwoods.com/content/23729 | |
| dc.rights.journal | http://www.longwoods.com/publications/healthcare-policy | en_US |
| dc.rights.publisher | http://www.longwoods.com/ | en_US |
| dc.title | Patients' perceptions of joint replacement care in a changing healthcare system: a qualitative study | |
| dc.type | Article | en_US |