Increasing Knee Replacements for African-American Vets

PHILADELPHIA — Even though joint-replacement surgery is considered one of the most effective treatments for end-stage knee osteoarthritis, relieving pain in more than 90% of patients, African-Americans are much less likely than whites to consider it as an option.

Consequently, those patients are up to five times less likely to undergo the procedure — something VA researcher Said Ibrahim, MD, MPH, calls “one of the most marked disparities in healthcare.”

Ibrahim and his colleagues reported last year in the journal Arthritis and Rheumatism about an educational initiative that seeks to change that statistic.

The two-part intervention includes a decision aid, a 40-minute educational video about treatment options for knee osteoarthritis provided by the Foundation for Informed Medical Decision-Making as well as a single session of counseling based on motivational interviewing.

The study included 639 African-American patients — all with moderate to severe osteoarthritis of the knee — at the Philadelphia, Pittsburgh and Cleveland VAMCs. With participants randomly assigned to four groups, one group watched the video, a second watched the video and received counseling afterward, a third received only counseling and a fourth was given an educational booklet about osteoarthritis that did not specifically talk about joint replacement.

With any intervention, patient willingness to consider joint replacement rose from 67% to 75%, on average, at the one-month follow-up, according to study results. After a year, patients in the intervention groups were more likely than those in the control group to report that they talked to their provider about knee pain (92% vs. 85%), got a referral to an orthopedic surgeon (18% vs. 13%) and, for those with referrals, attended an orthopedic consult (61% vs. 50% percent).

Ibrahim said the intervention was based on earlier studies that documented the gap between African-Americans and whites in the use of joint replacement.

“We did surveys to identify the potential differentiating factors between African-Americans and whites that could explain the disparities, and we found that one key factor was lack of knowledge among African-Americans about the treatment itself. That’s how we made the decision to use the video — it provides exactly the information we think African-Americans need to feel comfortable with this treatment,” he explained.

1Ibrahim SA, Hanusa BH, Hannon MJ, Kresevic D, Long J, Kent Kwoh C. Willingness and Access to Joint Replacement Among African-American Patients With Knee Osteoarthritis: A Randomized, Controlled Intervention. Arthritis & Rheumatism, 65: 1253-1261.

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