PCPs often assigned a low priority to OA as a disease |
“A lot of patients who are older have diabetes, hypertension, and hyperlipidemia, but if they have OA in their knees and it’s affecting their ability to move, and walk, and function, that’s what’s top of mind for them so they bring it forward and they want help with it” (Interview 6, female, academic family practice) “Mostly, they don’t come in for their arthritis. It’s not their arthritis they come in for” (Interview 1, female, academic family practice) “[Patients say] ‘I can’t do what I used to do’ or ‘My knees creak’ or ‘I can’t …’ and so we talk about what the normal process of aging is” (Interview 3, female, academic family practice)
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Exercise, the main treatment for OA, is often not perceived as a “real” medical treatment |
“I would never just prescribe or advise exercise alone as the treatment [for knee OA]” (Interview 10, male, community family practice) “Nothing really seems to work [to treat knee OA–related pain]” (Interview 1, female, academic family practice) “But it’s hard to do [exercises] long enough to see that you may get that benefit” (Interview 1, female, academic family practice)
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Prescribing exercise is perceived as being outside of most PCPs’ scope of practice |
“The other thing is I’m not sure if family docs … know how much to recommend exactly” (Interview 2, female, academic family practice) “I probably never really looked into learning about it and I never was taught it [exercise prescription]” (Interview 4, female, community family practice) “I certainly encourage them to walk, at the very least. But some of them, I think, need more than that so sometimes I wish that I could get more in the way of a physiotherapy program that would at least get them started on a good exercise routine” (Interview 6, female, academic family practice) “I don’t feel like we have great algorithms for managing it [exercise]” (Interview 4, female, community family practice) “But practically, I find it difficult to prescribe it [exercise]” (Interview 10, male, community family practice)
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PCPs often account for success or failure of prescribing exercise as being the function of individual patient motivation |
“[Many patients are] lazy, or want a quick fix, or don’t want to work at it to get the desired results” (Interview 2, female, academic family practice) “I’m always surprised when they actually do it [exercise]” (Interview 3, female, academic family practice) “I honestly have not suggested it to her. I haven’t … I’ve probably just projected that she wouldn’t be interested, which is unfair. So, it’s unfair for me not to have gone there with her” (Interview 3, female, academic family practice) “I try to get people to walk, for sure ... but older people don’t … it’s challenging” (Interview 1, female, academic family practice) “When they come back and you ask ‘Have you done the exercises,’ most of them have not done them” (Interview 2, female, academic family practice) “Well, the challenge for a lot of them is finding programs, and they seem to have a bit of trouble motivating themselves to do it on their own” (Interview 6, female, academic family practice) “They [patients] have to know that it’s going to make them feel better because otherwise, there’s low motivation to do it” (Interview 4, female, community family practice)
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