Equitable person-centred osteoarthritis care

Funding

Arthritis Society

Aim

Women experience greater prevalence of osteoarthritis (OA) but are less likely than men to be diagnosed or treated, particularly racialized immigrant women. As a result, many women needlessly suffer with worsening OA pain and disability, affecting all aspects of their lives. We aimed to identify strategies needed to improve access to and quality of OA care for any disadvantaged group including diverse women through review of prior research, analysis of OA guidelines and policies and interviews with key informants.

Key Findings

  • A rapid review of 11 studies published from 2010 to 2021 included few strategies and only 5 (45.5%) studies described how they tailored strategies for disadvantaged groups. All strategies targeted patients to support self-management. No strategies targeted clinicians or the healthcare system even though prior research showed that clinician- and system-level barriers impeded access to and quality of OA care for disadvantaged groups. [Arthritis Care & Research 2023]
  • Among 36 OA guidelines published from 2003 to 2021, few (14, 38.8%) acknowledged greater prevalence of OA by intersectional factors such as gender or related barriers or challenges in accessing OA care (3, 8.3%). Only 2 guidelines offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to self-manage OA. [BMC Musculoskeletal Disorders 2023;24:734
  • Among 14 Canadian organizational policies published from 2004 to 2021, few (7, 50.0%) acknowledged greater prevalence of OA by intersectional factors such as gender that contribute to barriers or challenges in accessing OA care (9, 64.2%). Few (5, 35.7%) policies included strategies to address inequities in OA care and most targeted patients (e.g. self-management). [BMC Health Services Research 2023;in press]  
  • Interviews with 27 ethno-culturally diverse women with OA and 31 healthcare professionals of differing specialties revealed that both groups identified similar:
    • Barriers of equitable access to OA care at the patient (e.g. no primary care provider, English as a second language, no health benefits), clinician (e.g. lack of knowledge about OA management or cultural tailoring of care) and healthcare system (e.g. few resources in rural communities, no equity considerations in policies) levels
    • Strategies to support equitable access to OA care at the patient (e.g. offer OA self-management support and peer support in many languages, formats and settings), clinician (e.g. medical and continuing education on OA management, provide OA management tools, supply with OA information for patients) and healthcare system (e.g. self-referral, public health promotion, publicly fund OA services, OA-specific clinics) levels. [Equity in Health 2023;22:207]
  • A Delphi survey of ethno-culturally diverse women with OA and healthcare professionals from across Canada generated strong consensus on 27 strategies to support equitable access to person-centered care for women with OA: [BMJ Open 2023;in press]
    • 7 patient-level (consider patients’ cultural needs and economic circumstances)
    • 7 clinician-level (e.g. inquire about OA management needs and preferences)
    • 13 system-level (e.g. implement OA-specific clinics)

Impact

We identified multi-level strategies that could be implemented by healthcare professionals, organizations or systems to mitigate inequities, and improve OA care for diverse women. Further research may be needed to establish how best to implement these strategies.