title: Personal Perspectives on Enablers and Barriers to Accessing Care for Hip and Knee Osteoarthritis.
abstract: BACKGROUND
  Despite increasing demand for joint replacement surgery and other health services for hip and knee osteoarthritis (OA), barriers and enablers to individual access to care are not well understood. A comprehensive understanding of drivers at all levels is needed to inform efforts for improving access.
  
  
  OBJECTIVE
  The aim of this study was to explore perceived barriers and enablers to receiving conservative (nonsurgical) and surgical treatment for hip and knee OA.
  
  
  METHODS
  This was a qualitative study using directed content analysis.
  
  
  METHODS
  Semistructured telephone interviews were conducted, with 33 participants randomly sampled from an Australian population-based survey of hip and knee OA. Each interview covered factors contributing to receiving treatment for OA and perceived barriers to accessing care. Interview transcripts were coded and organized into themes.
  
  
  RESULTS
  Key barriers to accessing care for OA included medical opinions about saving surgery for later and the appropriate age for joint replacement. Other common barriers included difficulty obtaining referrals or appointments, long waiting times, work-related issues, and limited availability of primary and specialist care in some areas. Several participants perceived a lack of effective treatment for OA. Private health insurance was the most frequently cited enabler and was perceived to support the costs of surgical and conservative treatments, including physical therapy, while facilitating faster access to surgery. Close proximity to services and assistance from medical professionals in arranging care also were considered enablers.
  
  
  CONCLUSIONS
  People with hip or knee OA experience substantial challenges in accessing treatment, and these challenges relate predominantly to health professionals, health systems, and financial factors. Private health insurance was the strongest perceived enabler to accessing care for OA.
authors.affiliation: I.N. Ackerman, BPhysio(Hons), PhD, Department of Medicine, Royal Melbourne Hospital, Melbourne EpiCentre, The University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia. i.ackerman@unimelb.edu.au.
authors.forename: Ilana N
authors.initials: IN
authors.lastname: Ackerman
authors.affiliation: J.A. Livingston, BSc, MEd, Centre for Health and Society, Melbourne School of Population and Global Health, The University of Melbourne.
authors.forename: Jenni A
authors.initials: JA
authors.lastname: Livingston
authors.affiliation: R.H. Osborne, BSc, PhD, Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
mesh_terms: D000368:Aged; D001294:Attitude to Health; D001315:Australia; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000628:therapy*; D036301:Qualitative Research