Factors influencing physician recommendation for intra-articular therapies in osteoarthritis: A qualitative study.

Objective Several current and many emerging osteoarthritis (OA) treatments are intra-articular (IA) injections. However, little is known about physicians' perceptions and beliefs regarding IA injections or their considerations when deciding whether to recommend them to patients. We aimed to investigate physician-perceived benefits and drawbacks of offering IA injections. Methods We conducted individual interviews with orthopedic surgeons, rheumatologists, and physiatrists who treat patients with knee OA. We conducted a thematic analysis to identify factors that physicians weigh when making IA injection recommendations. Results We interviewed 18 physicians from academic and community practices. We identified four categories of themes that influenced providers' recommendations to their patients regarding injections: 1) the physician's knowledge, beliefs, and concerns, including their propensity to rely on guidelines versus clinical experience, and understanding of the efficacy and risks associated with injectables, such as possible cartilage damage; 2) the characteristics of the injectable product, such as ease or number of administrations needed; 3) individual patient-specific factors, including OA severity, comorbidities, and patient preference for and expectations of specific IA injections; and 4) financial and administrative factors, including insurance coverage and out-of-pocket costs. Conclusion Physicians factor the uncertain efficacy of injectable treatments and the need to manage patient expectations into their decision to offer IA therapies. Some providers relied on evidence and guidelines while others were swayed more by clinical experience. High out-of-pocket costs were seen as a barrier to use. These findings may help in the delivery of IA injections for OA and in development of injectable products.