title: Patients' perceptions of navigating "the system" for arthritis management: are they able to follow our recommendations?
abstract: OBJECTIVE
  To understand whether a visit to a Hip/Knee Arthritis Assessment Centre (AC), where non-surgical candidates with arthritis are directed toward community resources and provided with a conservative treatment "prescription," contributes to patients' self-management and ability to access community resources.
  
  
  METHODS
  A purposive sample of non-surgical patients was contacted 3-10 months after their AC visit. Three focus groups (n=20) and 20 semi-structured telephone interviews were conducted. Transcripts were systematically coded and analyzed using a qualitative descriptive research methodology.
  
  
  RESULTS
  While participants generally reported that the AC visit improved self-management, analysis identified an emergent theme about the inadequacy of conservative management in general, subdivided into two sub-themes related to (1) limited access to high-quality, non-surgical treatment, such as physiotherapy and (2) health care providers' attitudes and approaches, which do not embrace chronic disease prevention and management.
  
  
  CONCLUSIONS
  An AC visit contributes to arthritis self-management; however, the current health care system does not adequately support conservative treatment of chronic conditions. Treatment guidelines need to be tailored to the local health care context in which they are applied.
authors.affiliation: Hospital for Sick Children, Toronto.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Winter Di Cola
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy.
authors.forename: Shahiroz
authors.initials: S
authors.lastname: Juma
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy ; School of Rehabilitation Science, McMaster University, Hamilton, Ont.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kennedy
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Occupational Science and Occupational Therapy.
authors.forename: Patricia
authors.initials: P
authors.lastname: Dickson
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Physical Therapy ; School of Rehabilitation Science, McMaster University, Hamilton, Ont.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Denis
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre.
authors.forename: Susan
authors.initials: S
authors.lastname: Robarts
authors.affiliation: Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre ; Department of Surgery.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gollish
authors.affiliation: Department of Family and Community Medicine ; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
keywords: disease management; health services accessibility; osteoarthritis; survey