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Rationale, aims and objectives As total joint arthroplasty ( TJA) rates rise, there is need to ensure appropriate use. Our objective was to elucidate surgeons' perspectives on appropriateness for TJA. Methods Semi-structured telephone interviews were conducted in a sample of orthopaedic surgeons that perform TJA in three Canadian Provinces. Surgeons were asked to discuss their criteria for TJA appropriateness for osteoarthritis; potential value of a decision-support tool to select appropriate candidates; and the role of other stakeholders in assessing appropriateness. Results Of 17 surgeons approached for participation, 14 completed interviews (12 males; 7 aged <50 years; 5 academic; 8 in urban practices). Surgeons agreed that pain and pain impact on patients' quality of life and function were the key criteria to assess appropriateness for TJA, but that these concepts were difficult to assess and not always congruent with structural changes on joint radiography. Some used a wider range of criteria, including their assessments of patient expectations, ability to cope and readiness for surgery. While patient age was not identified as a criterion itself, surgeons did acknowledge that appropriateness criteria may differ for younger versus older patients. Most agreed that a decision-support tool would help ensure that all elements of appropriateness are assessed in a standardized manner, albeit the ultimate decision to offer surgery must be left to the discretion of surgeons, within the context of the doctor-patient relationship. Conclusions Surgeons recognized the need for a tool to support decision making for TJA, particularly in the context of increasing surgical demand in younger patients with less severe arthritis. The work to develop and test such a decision-support tool is underway. [ABSTRACT FROM AUTHOR]

Background: This analysis explores barriers to the receipt of health care from a primary care physician for management of chronic conditions., Data and Methods: A population-based survey was administered to adults in Manitoba, Saskatchewan, Alberta and British Columbia who had hypertension, diabetes, heart disease or stroke (n=1,849). Associations between socio-demographic factors and barriers to receipt of primary care were identified., Results: Most respondents with chronic conditions required care from a primary care physician in the past year and had no difficulty receiving it; about 10% reported a barrier. Barriers were most commonly reported by respondents with diabetes (16%) and were related to initiation of care or waiting too long to get care., Interpretation: A small percentage of adults with chronic conditions report barriers to receiving care from a primary care physician.