title: Primary care physicians' perceptions about and confidence in deciding which patients to refer for total joint arthroplasty of the hip and knee.
abstract: OBJECTIVE
  The purpose of this study is to examine the perceptions of primary care physicians (PCPs) regarding indications, contraindications, risks and benefits of total joint arthroplasty (TJA) and their confidence in selecting patients for referral for TJA.
  
  
  METHODS
  PCPs recruited from among those providing care to participants in an established community cohort with hip or knee osteoarthritis (OA). Self-completed questionnaires were used to collect demographic and practice characteristics and perceptions about TJA. Confidence in referring appropriate patients for TJA was measured on a scale from 1 to 10; respondents scoring in the lowest tertile were considered to have 'low confidence'. Descriptive analyses were conducted and multiple logistic regression was used to determine key predictors of low confidence.
  
  
  RESULTS
  212 PCPs participated (58% response rate) (65% aged 50+ years, 45% female, 77% >15 years of practice). Perceptions about TJA were highly variable but on average, PCPs perceived that a typical surgical candidate would have moderate pain and disability, identified few absolute contraindications to TJA, and overestimated both the effectiveness and risks of TJA. On average, PCPs indicated moderate confidence in deciding who to refer. Independent predictors of low confidence were female physicians (OR = 2.18, 95% confidence interval (CI): 1.06-4.46) and reporting a 'lack of clarity about surgical indications' (OR = 3.54, 95% CI: 1.87-6.66).
  
  
  CONCLUSIONS
  Variability in perceptions and lack of clarity about surgical indications underscore the need for decision support tools to inform PCP - patient decision making regarding referral for TJA.
authors.affiliation: Women's College Hospital, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada. Electronic address: e.waugh@utoronto.ca.
authors.forename: E J
authors.initials: EJ
authors.lastname: Waugh
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: E M
authors.initials: EM
authors.lastname: Badley
authors.affiliation: Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: C M
authors.initials: CM
authors.lastname: Borkhoff
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Croxford
authors.affiliation: Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Division of Healthcare and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Gignac
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S B
authors.initials: SB
authors.lastname: Jaglal
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Sale
authors.affiliation: Women's College Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: G A
authors.initials: GA
authors.lastname: Hawker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D000075202:Contraindications; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D018579:Patient Selection; D058007:Physicians, Primary Care / Q000523:psychology / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards
keywords: Osteoarthritis; Physician opinion; Primary care physicians; Total joint arthroplasty