SATISFACTION WITH PRE-OPERATIVE ARTHROPLASTY EDUCATION: PRIVATE VERSUS PUBLIC PATIENTS IN URBAN AUSTRALIA

Introduction Pre-operative patient education prior to hip and knee arthroplasty is thought to be beneficial for patients in general, although the clinical effect is unproven. Pre-operative education is now standard practice in many orthopaedic units, including our own. Anecdotally, we found patients in the private sector to be more satisfied with their education than those in the public sector, despite very similar education programs. We set out to investigate this observation and establish whether there were differences in the perception of educational quality between these groups. Methods After appropriate power calculation, 60 patients in each group (120 total) were interviewed after hip or knee arthroplasty. Satisfaction with education was assessed on a simple 5 point scale and demographic data including internet access was obtained, as well as Short-Form 12 (SF-12) data to establish physical and mental function. The education program in each group was similar, with written material provided and verbal education given at a single pre-operative session. This included specialist nursing and physiotherapy input. Results were analysed with the chi2 test, Mann-Whitney U test and logistic regression as appropriate, with significance at P<0.05. Results Overall, there was a high level of satisfaction in both groups but patients in the private sector were significantly more satisfied with their pre-operative education. Significant differences were identified between the groups in provision of written information, provision of internet resources, access to the internet, attendance at education sessions and the mental component score of the SF-12. Logistic regression modelling showed that factors influencing satisfaction rates were interdependent. The relationship between lower SF-12 mental component scores and lower satisfaction rates was linear. Conclusion Private patients are more satisfied with their pre-operative education than public patients, a disparity which may be due to several demographic and educational factors including lower SF-12 mental component scores. The relationships between these factors are complex and not independent. Satisfaction in the public sector may be improved by improving attendance rates at education sessions. However, public patients may not benefit from advances in education that rely on internet access or computer use. Although the use of the internet and computers in general is gaining support, it may not be as beneficial to patients in the public sector as the private sector. This has implications for service provision and planning in arthroplasty units.