General practitioners' perceptions and experiences of knee osteoarthritis management: a qualitative study of barriers and facilitators to delivering guideline-recommended treatments.

چکیده اصلی

BACKGROUND: Knee osteoarthritis (OA) is a prevalent condition and public health concern. Guidelines recommend non-surgical treatments - such as education, exercise and weight management - as core elements of OA management; however, uptake remains low. General practitioners (GPs) play a crucial role in delivery, yet little is known about how GPs navigate OA treatments in the Scandinavian context. AIM: To explore Danish GPs' perceptions and experiences of knee OA management, focusing on treatments and referral, and to identify key barriers and facilitators to delivering guideline-recommended treatments. METHODS: Twelve semi-structured online interviews were conducted with GPs and GP trainees. Participants were recruited through a combination of convenience and self-selection sampling. Data were analyzed inductively using thematic analysis. RESULTS: Four themes were identified: (1) knowledge and practice extend beyond guidelines, (2) non-surgical treatments are limited and inconsistently provided, (3) conceptual and relational tensions are negotiated and (4) fostering patient motivation is challenging. CONCLUSION: GPs displayed generally up-to-date knowledge of core non-surgical treatments, although familiarity with referral criteria was more variable. They held positive attitudes toward exercise and physiotherapy-led treatment, but experienced limited active dissemination of guidelines. Structural barriers, including fragmented pathways and uneven municipal services limited delivery of non-surgical treatments. Weight loss was viewed as effective in relieving joint pain but an unsustainable treatment focus, highlighting the need for a feasible, weight-inclusive approach to weight management. Strengthening cross-sector coordination, developing and implementing multidisciplinary OA services as well as clarifying where responsibility for fostering patient motivation should be placed, may enhance delivery of non-surgical care.

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