What are patients’ and primary care clinicians’ views and experiences of using intra-articular corticosteroid injections for osteoarthritis? A qualitative interview study
Problem
Osteoarthritis is a leading cause of joint pain and disability. Intra-articular corticosteroid injections (IACs) are often used in primary care to provide short-term relief of osteoarthritis symptoms. However, limited evidence exists on their long-term efficacy and safety. As osteoarthritis rates rise, understanding patient and clinician perspectives becomes crucial for informing practice and policy recommendations. In this study we aimed to explore patients’ and primary care clinicians’ experiences and views about the use of IACIs for osteoarthritis.
Approach
Our qualitative study involved telephone/videocall interviews with 38 patients, 16 General Practitioners (GPs), and 3 First Contact Practitioners (FCPs) in 2021. A purposive sampling strategy was used to identify and recruit patients and clinicians from 10 primary care practices in the Southwest of England. Topic guides were developed in collaboration with clinical team members and Patient and Public Involvement and Engagement representatives. All participants provided written informed consent. Interviews were transcribed and analysed using an inductive thematic approach with 25% of transcripts independently coded by a second researcher. The study received ethical approval in July 2020.
Findings
Our analysis revealed six patient themes: variation in access, awareness of IACIs, views on risk and trust in GPs, perceived effectiveness, variation in effectiveness and duration, and seeking alternatives. Among GPs and FCPs we identified an overarching theme of caution and competence, encompassing eight subthemes including: confidence with procedures, risk concerns, training needs, uncertainty about evidence, technical issues, use in the osteoarthritis pathway, perceived benefits, and the potential for placebo effects. Key insights from the study included the variability in IACI access, which is linked to GPs' cautiousness and confidence. Caution is influenced by ad hoc training, concerns over risk of adverse outcomes, and a limited evidence base. In terms of treatment preferences, both patients and clinicians valued IACIs for improving quality of life and were an alternative to less desirable treatments. Finally, GPs tended to reserve IACIs as a last resort before considering surgery.
Consequences
The study highlights a need for improved patient access to IACIs, with a focus on enhancing clinicians' confidence and competence in administering these injections. GPs tended to use IACIs as a last resort before considering surgery, which may mean that IACIs are not provided at the optimal time for achievement of patient benefit. It may be the case that many patients are towards the end of the inflammatory phase of osteoarthritis when they are offered IACs, therefore cutting short the potential benefit of IACIs to serve patients longer as an effective treatment against symptomatic osteoarthritis. GPs expressed concern that they lacked the necessary skills and confidence to administer IACIs, which suggests that there may be a potential role for FCPs to deliver treatment.