192 lines
6.3 KiB
YAML
192 lines
6.3 KiB
YAML
abstract: 'Background: Documented age, gender, race and socio-economic disparities
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in total joint arthroplasty (TJA), suggest that those who need the
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surgery may not receive it, and present a challenge to explain the
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causes of unmet need. It is not clear whether doctors limit treatment
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opportunities to patients, nor is it known the effect that patient
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beliefs and expectations about the operation, including their paid work
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status and retirement plans, have on the decision to undergo TJA.
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Identifying socio-economic and other determinants of demand would inform
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the design of effective and efficient health policy. This review was
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conducted to identify the factors that lead patients in need to undergo
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TJA.
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Methods: An electronic search of the Embase and Medline (Ovid)
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bibliographic databases conducted in September 2011 identified studies
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in the English language that reported on factors driving patients in
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need of hip or knee replacement to undergo surgery. The review included
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reports of elective surgery rates in eligible patients or, controlling
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for disease severity, in general subjects, and stated clinical experts''
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and patients'' opinions on suitability for or willingness to undergo TJA.
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Quantitative and qualitative studies were reviewed, but quantitative
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studies involving fewer than 20 subjects were excluded. The quality of
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individual studies was assessed on the basis of study design (i.e.,
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prospective versus retrospective), reporting of attrition, adjustment
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for and report of confounding effects, and reported measures of need
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(self-reported versus doctor-assessed). Reported estimates of effect on
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the probability of surgery from analyses adjusting for confounders were
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summarised in narrative form and synthesised in odds ratio (OR) forest
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plots for individual determinants.
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Results: The review included 26 quantitative studies-23 on individuals''
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decisions or views on having the operation and three about health
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professionals'' opinions-and 10 qualitative studies. Ethnic and racial
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disparities in TJA use are associated with socio-economic access factors
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and expectations about the process and outcomes of surgery. In the
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United States, health insurance coverage affects demand, including that
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from the Medicare population, for whom having supplemental Medicaid
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coverage increases the likelihood of undergoing TJA. Patients with
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post-secondary education are more likely to demand hip or knee surgery
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than those without it (range of OR 0.87-2.38). Women are as willing to
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undergo surgery as men, but they are less likely to be offered surgery
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by specialists than men with the same need. There is considerable
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variation in patient demand with age, with distinct patterns for hip and
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knee. Paid employment appears to increase the chances of undergoing
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surgery, but no study was found that investigated the relationship
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between retirement plans and demand for TJA. There is evidence of
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substantial geographical variation in access to joint replacement within
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the territory covered by a public national health system, which is
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unlikely to be explained by differences in preference or unmeasured need
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alone. The literature tends to focus on associations, rather than
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testing of causal relationships, and is insufficient to assess the
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relative importance of determinants.
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Conclusions: Patients'' use of hip and knee replacement is a function of
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their socio-economic circumstances, which reinforce disparities by
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gender and race originating in the doctor-patient interaction.
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Willingness to undergo surgery declines steeply after the age of
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retirement, at the time some eligible patients may lower their
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expectations of health status achievement. There is some evidence that
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paid employment independently increases the likelihood of operation. The
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relative contribution of variations in surgical decision making to
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differential access across regions within countries deserves further
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research that controls for clinical need and patient lifestyle
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preferences, including retirement decisions. Evidence on this question
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will become increasingly relevant for service planning and policy design
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in societies with ageing populations.'
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affiliation: 'Mota, REM (Corresponding Author), Univ Exeter, Inst Hlth Serv Res, Veysey
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Bldg,Salmon Pool Lane, Exeter EX2 4SG, Devon, England.
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Mota, Ruben E. Mujica, Univ Exeter, Inst Hlth Serv Res, Exeter EX2 4SG, Devon, England.
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Tarricone, Rosanna; Ciani, Oriana, Univ Bocconi, Ctr Res Healthcare Management,
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I-20136 Milan, Italy.
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Bridges, John F. P., Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD 21205
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USA.
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Drummond, Mike, Univ York, Ctr Hlth Econ, York YO10 5DD, N Yorkshire, England.'
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article-number: '225'
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author: Mota, Ruben E. Mujica and Tarricone, Rosanna and Ciani, Oriana and Bridges,
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John F. P. and Drummond, Mike
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author-email: r.e.mujica-mota@exeter.ac.uk
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author_list:
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- family: Mota
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given: Ruben E. Mujica
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- family: Tarricone
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given: Rosanna
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- family: Ciani
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given: Oriana
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- family: Bridges
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given: John F. P.
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- family: Drummond
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given: Mike
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da: '2023-09-28'
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doi: 10.1186/1472-6963-12-225
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eissn: 1472-6963
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files: []
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journal: BMC HEALTH SERVICES RESEARCH
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keywords: 'Orthopaedic implant; Arthroplasty; Hip; Knee; Demand; Need; Equity;
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Preferences; Patient selection; Osteoarthritis; Decision to operate;
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Socio-economic disparities; Total joint replacement'
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keywords-plus: 'QUALITY-OF-LIFE; JOINT REPLACEMENT SURGERY; WILLINGNESS-TO-PAY; AGED
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55
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YEARS; DECISION-MAKING; ORTHOPEDIC SURGEONS; PATIENT PREFERENCES;
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PRIMARY-CARE; POPULATION REQUIREMENT; SOCIOECONOMIC-STATUS'
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language: English
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month: JUL 30
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number-of-cited-references: '109'
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orcid-numbers: 'Ciani, Oriana/0000-0002-3607-0508
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Mujica-Mota, Ruben/0000-0002-7430-2744
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TARRICONE, ROSANNA/0000-0002-2009-9357'
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papis_id: b783b371f4d2e82b7092127ebf1b9828
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ref: Mota2012determinantsdemand
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researcherid-numbers: 'Ciani, Oriana/D-1455-2015
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'
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tags:
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- review
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times-cited: '95'
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title: 'Determinants of demand for total hip and knee arthroplasty: a systematic literature
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review'
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type: article
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unique-id: WOS:000310348400001
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usage-count-last-180-days: '2'
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usage-count-since-2013: '48'
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volume: '12'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2012'
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