Determinants of patient preferences for total knee replacement: African-Americans and whites.
Determinants of patient preferences for total knee replacement: African-Americans and whites.
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DOI：
10.1186/s13075-015-0864-2
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发表时间：
2015-12-03
影响因子：
4.9
通讯作者：
Ibrahim SA
中科院分区：
文献类型：
--
作者：
Kwoh CK;Vina ER;Cloonan YK;Hannon MJ;Boudreau RM;Ibrahim SA
患者偏好导致全膝关节置换术（TKR）使用的明显种族差异。本研究的目的是确定膝关节骨关节炎（OA）患者对TKR偏好的决定因素，并确定可能介导TKR意愿种族差异的变量。514例白色（WH）和285例非裔美国人（AA）慢性膝关节疼痛和OA影像学证据患者参加了本研究。参与者是从社区，学术医疗中心和退伍军人事务医院招募的。进行结构化访谈，以收集社会人口统计资料，疾病的严重程度，社会文化决定因素，和治疗偏好。进行逻辑回归，按种族分层，以确定偏好的决定因素。临床和社会文化因素同时进入模型。逐步选择确定了纳入最终模型的因素（p < 0.20）。与WH相比，AA不太愿意接受TKR（分别为80%和62%）。对TKR手术结局的更好预期决定了两种AA（第四与第一四分位数的比值比（OR）2.08，95%置信区间（CI）0.91-4.79）和WHs（第四与第一四分位数的OR 5.11，95% CI 2.31-11.30）的手术意愿。在认可机构中，（OR 1.80，95% CI 0.97-3.35），认为住院时间短（OR 0.81，95% CI 0.58-1.13），并认为术后疼痛较轻（OR 0.73，95%CI 0.39-1.35）和行走困难（OR 0.66，95%CI 0.37-1.16）也决定了意愿。在WH中，与医生进行手术讨论（OR 1.96，95% CI 1.05-3.68）、从未接受手术转诊（OR 0.56，95% CI 0.32-0.99）和对医疗保健系统的更高信任（第四与第一四分位数的OR 1.58，95% CI 0.75-3.31）也决定了意愿。在考虑的变量中，只有与TKR相关的知识相关的问题减弱了膝关节OA患者治疗偏好的种族差异。对手术结果的预期影响所有患者对TKR的偏好，但临床和社会文化因素的存在形成了TKR偏好的明显种族差异。减少或消除在使用TKR方面的种族差异的干预措施应考虑并针对这些因素。本文的在线版本（doi：10.1186/s13075-015-0864-2）包含补充材料，可供授权用户使用。
Patient preferences contribute to marked racial disparities in the utilization of total knee replacement (TKR). The objectives of this study were to identify the determinants of knee osteoarthritis (OA) patients’ preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR. Five hundred fourteen White (WH) and 285 African-American (AA) patients with chronic knee pain and radiographic evidence of OA participated in the study. Participants were recruited from the community, an academic medical center, and a Veterans Affairs hospital. Structured interviews were conducted to collect socio-demographics, disease severity, socio-cultural determinants, and treatment preferences. Logistic regression was performed, stratified by race, to identify determinants of preferences. Clinical and socio-cultural factors were entered simultaneously into the models. Stepwise selection identified factors for inclusion in the final models (p < 0.20). Compared to WHs, AAs were less willing to undergo TKR (80 % vs. 62 %, respectively). Better expectations regarding TKR surgery outcomes determined willingness to undergo surgery in both AAs (odds ratio (OR) 2.08, 95 % confidence interval (CI) 0.91-4.79 for 4th vs. 1st quartile) and WHs (OR 5.11, 95 % CI 2.31-11.30 for 4th vs. 1st quartile). Among AAs, better understanding of the procedure (OR 1.80, 95 % CI 0.97-3.35), perceiving a short hospital course (OR 0.81, 95 % CI 0.58-1.13), and believing in less post-surgical pain (OR 0.73, 95 % CI 0.39-1.35) and walking difficulties (OR 0.66, 95 % CI 0.37-1.16) also determined willingness. Among WHs, having surgical discussion with a physician (OR 1.96, 95 % CI 1.05-3.68), not ever receiving surgical referral (OR 0.56, 95 % CI 0.32-0.99), and higher trust in the healthcare system (OR 1.58, 95 % CI 0.75-3.31 for 4th vs. 1st quartile) additionally determined willingness. Among the variables considered, only knowledge-related matters pertaining to TKR attenuated the racial difference in knee OA patients’ treatment preference. Expectations of surgical outcomes influence preference for TKR in all patients, but clinical and socio-cultural factors exist that shape marked racial differences in preferences for TKR. Interventions to reduce or eliminate racial disparities in the utilization of TKR should consider and target these factors. The online version of this article (doi:10.1186/s13075-015-0864-2) contains supplementary material, which is available to authorized users.