A functional model of primary healthcare within the regional healthcare system for patients with degenerative-dystrophic conditions and major joints

Abstract

Degenerative joint diseases of the large joints (hip and knee) remain among the leading causes of chronic pain, functional limitation and reduced quality of life in the adult population. The prevalence of these conditions is rising in parallel with population ageing, accompanied by growing demand for arthroplasty. In modern integrated models of care, primary health care (PHC) is regarded as the first and continuous level of managing such patients; however, in the literature and clinical guidelines its functions are described mostly fragmentarily, in relation to separate clinical stages (diagnosis, conservative treatment, referral), while the role of PHC at the stages of preoperative preparation, postoperative follow-up and long-term monitoring remains far less addressed. This limits the scientific substantiation of the role of PHC within an optimised regional care system. Aim. To substantiate a functional model of PHC as a component of an optimised regional care system by defining PHC functions at each stage of the patient pathway for degenerative joint disease and large-joint trauma. Materials and methods. The study is theoretical and conceptual, based on the analysis of scientific publications and international clinical guidelines, including those of NICE, materials on implementing these guidelines into PHC practice, and concepts of value-based models of care. Bibliosemantic analysis, content analysis of clinical guidelines, structural-functional analysis, functional decomposition of the patient pathway as the principal original methodological approach, and conceptual modelling were applied. Results. Seven sequential stages of the patient pathway were identified: initial presentation, primary clinical assessment, conservative management, referral, preoperative preparation, postoperative follow-up, and long-term monitoring. For each stage, the aim, the role of PHC and the core functions were defined and summarised in a functional matrix together with the expected outcome of each function. Unlike existing models, which describe the role of PHC fragmentarily and link it to one or two stages, the proposed model is the first to integrate PHC functions across the full patient pathway, positioning PHC as an end-to-end coordinator rather than an episodic participant in specialised care. Conclusions. The functional model of PHC provides a conceptual basis for defining requirements for the performance of each function and for developing a validated tool to assess PHC readiness for integration into an optimised regional care system for patients with large-joint pathology. The model requires further empirical validation involving family physicians, orthopaedic surgeons and health care managers.