Barriers and enablers to the management of osteoarthritis in primary care in Ireland from the perspective of healthcare professionals and individuals with osteoarthritis: a qualitative study using the Theoretical Domains Framework

Abstract

Objectives: To explore the barriers and enablers to providing and receiving primary care for osteoarthritis (OA) in Ireland from the perspectives of primary care healthcare professionals (HCPs) and individuals with OA.

Design: Descriptive qualitative study incorporating an inductive thematic analysis to identify key barrier and enabler themes and subsequent deductive mapping to the Theoretical Domains Framework (TDF).

Setting: Primary care in Ireland.

Participants: HCPs, including 6 general practitioners, 5 physiotherapists, 1 occupational therapist and 1 practice nurse, and 13 individuals with OA were interviewed.

Results: Identified barriers and enablers related to nine domains of the TDF. Key barriers identified by HCPs included limited and delayed access to multidisciplinary primary care services, lack of integrated care pathways specific to OA and insufficient training in musculoskeletal conditions including OA. Individuals with OA also reported poor access to health services due to long waiting lists, lack of education on OA and feelings of not being taken seriously by HCPs. There is a need for targeted HCP education and training to address the identified knowledge, skills and confidence gaps in communication, diagnosis and evidence-based management of OA. Improved management of OA through system-level changes, including integrated care pathways with multidisciplinary services to better support individuals with OA in the community, is required.

Conclusions: This study identified several barriers and enablers to the management of OA. These findings highlight areas to be targeted by future interventions aimed at improving the management of OA in primary care.

Keywords: Musculoskeletal disorders; Primary Health Care; QUALITATIVE RESEARCH; Quality in health care.