Management of progressive joint disorders by non-physician healthcare providers in South Africa: A mapping study to inform pharmacist integration

Abstract

BACKGROUND: Progressive joint disorders (PJDs), including osteoarthritis, rheumatoid arthritis (RA) and are leading causes of disability worldwide. Early multidisciplinary intervention is critical; however, delayed non-pharmacological management, fragmented referral pathways and limited integration of pharmacists, despite their potential role in medication management and early 'red flag' identification, remain common. AIM: To identify which PJDs are managed by which healthcare providers, to inform pharmacist referral pathways and promote integrated care. SETTING: Non-physician healthcare providers (HCPs) in South Africa, including physiotherapists, occupational therapists, chiropractors, podiatrists, osteopaths, biokineticists and other complementary therapy providers. METHODS: A quantitative, cross-sectional survey was administered via REDCap® and distributed by professional bodies through email and professional association platform advertisements. Descriptive statistics and quantitative content analysis assessed condition management, referral practices and collaboration. RESULTS: A total of 266 HCPs participated. Osteoarthritis (91.7%) and RA (84.6%) were the most managed conditions. High interprofessional collaboration was noted with physiotherapists (71.4%) and limited with pharmacists (23.3%). Most providers (76.3%) did not require referral letters. Referrals to and from other providers were common, but incoming referrals varied by profession. Internal consistency was acceptable (Cronbach's α 0.70). CONCLUSION: Progressive joint disorders were predominantly managed by chiropractors, physiotherapists and biokineticists. Referral pathways were inconsistent, and pharmacist integration remained limited.Contribution: This study presents the first national mapping of non-physician roles in PJD management in South Africa, providing critical insights for future development of pharmacist-inclusive referral guidelines.