317 THE INFLUENCE OF PATIENTS' GENDER ON PHYSICIANS' INTERPERSONAL BEHAVIOUR REGARDING TOTAL KNEE ARTHROPLASTY: WHAT IF YOUR PHYSICIAN DOESN'T ASK YOU TO DANCE?

Abstract

Purpose: To explore the determinants of help seeking by people in the community, who have lower limb pain.Methods: Health care utilisation, defined as having seen a family doctor (GP) or hospital doctor during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in 1079 persons reporting lower limb (hip/knee) pain from a community based sample aged 35 or over (The Somerset and Avon Survey of Health, SASH).Age and gender adjusted odds ratios were determined for: ethnicity, social deprivation, rurality, pain intensity (1-10, best-worst), the EQ5D mobility and anxiety/depression questions, the number of other self-reported health problems, and standard WHO categories of body mass index (BMI).A two-step cluster analysis was also performed to test associations between the variables.Results: Of the 1079 persons reporting pain in the hip or knee 18% had seen a doctor only, 2% an AHP only, and 4% an alternative therapist only.22% had seen more than one category of health care professionals (categorised 'COMB').54% had not seen any health care professional.People with mobility problems were 5 times more likely to visit an AHP (OR (95% CI) 5.54 (1.60-19.23)),and 3-4 times more likely to visit a GP (3.34 (2.19-5.08)),hospital doctor (2.83 (1.39-5.75)),or COMB (4.43 (3.06-6.43).Having two or more comorbidities doubled the likelihood of seeing a GP (2.43 (1.27-4.64))and 'COMB' (1.89 (1.13-3.16)),and caused a 3-fold increased likelihood of seeing a hospital doctor (3.36 (1.06-10.57))or alternative therapist (3.48 (1.22-9.91)).Pain severity was weakly associated with a visit to a GP (1.35 (1.22-1.50)or 'COMB' (1.57(1.43-1.72)).A visit to a GP was also associated with living in urban areas (2.46 (1.24-4.88))and obesity (2.34 (1.42-3.88)).Seeking 'COMB' was associated with anxiety/depression (1.78 (1.30-2.43)),overweight (2.05 (1.34-3.13))and obesity (2.50 (1.59-3.92)).The cluster analysis showed that more severe pain, mobility problems, more health problems, obesity, female gender and higher age were all associated with each other, and that people from this cluster were more likely to see a GP, hospital doctor, AHP and COMB, although 46% of those not currently using health care also belonged to this cluster.Conclusions: A majority of people living with hip and knee pain in the community do not seek help from health care professionals.Pain severity and perceived anxiety/depression seem to be of less importance to help seeking than reduced mobility, obesity, and comorbidities.People may cope well with hip and knee pain alone, but if they have other health problems or significant disability as well, they are more likely to seek professional help.