Strategies to Improve Equitable Access to Early Osteoarthritis Diagnosis and Management: An updated Review

Abstract

While OA affects millions of people worldwide, many fail to access recommended early, person‐centred OA care, particularly women who are disproportionately impacted by OA. A prior review identified few strategies to improve equitable access to early diagnosis and management for multiple disadvantaged groups. We aimed to update that review with literature published in 2010 or later on strategies to improve OA care for disadvantaged groups including women. We identified only 11 eligible studies of which only 2 (18%) focused on women only. Other disadvantaged groups targeted in the largely United States‐based studies included Black, Spanish‐speaking, rural and older (aged 60+) adults. All studies evaluated interventions targeted to patients: 4 (36%) assessed video decision aids and 7 (63.6%) assessed in‐person, video or telephone self‐management education. Interventions were often multi‐faceted (9, 82%) and most studies (8, 73%) achieved positive outcomes in at least some outcomes measured. No studies evaluated clinician‐ or system‐level strategies. Few (5, 45%) studies described how they tailored strategies to disadvantaged groups, or how they addressed person‐centred care concepts apart from enabling self‐management. Future research is needed to develop, implement, evaluate and scale‐up multi‐level strategies to enhance equitable, person‐centred OA care for disadvantaged groups including women.

Priority strategies to reduce socio-gendered inequities in access to person-centred osteoarthritis care: Delphi survey

“…We identified strategies from multiple sources (published research, guidelines, policies, diverse women, professionals of differing specialties) through primary research. 17 30–32 Strategies were rated by a larger number of respondents than is typical of most Delphi studies to ensure that participants reflected varied perspectives of women and professionals from across Canada to generate national consensus, and because larger sample size has been shown to enhance reliability. 27 28 Prioritised strategies reflect strong consensus within and across groups of women and professionals, and because they are multilevel, stand to address barriers identified at the patient-level, clinician-level and system-level.…”

“…We identified strategies through our prior research including a review of published research, content analysis of OA guidelines and policies and qualitative interviews with diverse women and healthcare professionals. 17 30–32 To derive strategies that populated the survey, from the aforementioned primary research, 17 30–32 we collated recommended strategies, and to these, added additional unique recommendations informed by determinants (eg, enablers or barriers of equitable access to OA care) framed as recommendations ( online supplemental appendix 1 ). We organised strategies as patient-level (offered to persons with OA to improve knowledge, confidence, behaviour, OA symptoms or quality of life); clinician-level (offered to clinicians to improve OA knowledge, skills or behaviour) or system-level (developed or offered by healthcare organisations or government to improve access to or quality of OA care, advice or support).…”

“…[12][13][14][15] A review of research conducted before 2010 identified only 10 studies of strategies to overcome inequities in OA care experienced by disadvantaged groups, 16 and an updated review identified only 11 such studies published from 2010 to 2022. 17 In both reviews, few studies focused solely on women. The earlier review included only one study that compared women with men, 16 and the updated review included only two studies focused on women only.…”

“…The earlier review included only one study that compared women with men, 16 and the updated review included only two studies focused on women only. 17 Strategies largely consisted of education or support for self-management for persons affected by OA. This may overcome patient-level barriers such as lack of knowledge about OA or self-management, but are unlikely to address additional known barriers at the healthcare professional (eg, OA not considered serious) or system level (eg, availability of support services) that contribute to gendered inequities in access to and quality of OA care.…”