Management of Osteoarthritis

Background

Arthritis is a chronic disease of the joints estimated to affect over five million Australians. Over two million of these have osteoarthritis (OA) which is the most common form of arthritis [1], though it is known that many go unreported as it is a common misguided belief that joint pain is a part of the normal process of ageing. It has been estimated that the number of people with OA in Australia will increase from 2.2 million in 2015 to 3.1 million in 2030; with the ageing population and increasing prevalence of obesity being two of the drivers of this increase. People with OA report living with chronic pain, physical disability, functional impairment, social and vocational difficulties in their daily life [2]. Comorbidities are common with 15% of the people accessing the ACI trial of the Osteoarthritis Chronic Care Program reporting four or more comorbidities.

Core Documents

What clinical processes need to change?

International and national guidelines for the management of OA recommend conservative care options as first line management strategies, even with increasing pain levels and functional disability. Conservative care includes the use of simple analgesia and multidisciplinary self-management support to include risk modifying behaviour in everyday life such as exercise and healthy eating habits. Data from the trial of the ACI Osteoarthritis Chronic Care Program (OACCP), conducted from 2011 through to 2013 has revealed that in a variety of sites across NSW, almost 70% of over 6,000 people on the waitlist for elective hip or knee joint replacement had not been referred to or accessed conservative care (besides analgesia) before referred to the surgical waitlist. To achieve the following outcomes, people referred require a minimum of 12 months enrolment in the OACCP to enable behavioural change to be embedded as a normal part of OA self-management.

The outcomes include:

What will the clinical change process look like?

The OACCP is a coordinated multidisciplinary model of care that can be used for people with OA of the hip and/or knee at all stages of the disease trajectory. While the model of care was evaluated in hospital outpatient settings with people who are already on the waitlist for surgical hip or knee joint replacement, trials led by the ACI Musculoskeletal Network since have been undertaken in primary care settings with collaboration and partnership between Local Health Districts (LHD) and Primary Health Networks (PHN). This indicated that OACCP is effective in consideration of improved patient outcomes and improved health system utilisation in outpatient settings. The interventions used to attain these results can be applied and trialled in various localities across NSW.

Key to the program at sites are:

What are the clinical benefits of change for this cohort?

Implementing the OACCP has the potential to:

Resources

Osteoarthritis Chronic Care - Program Monitoring and evaluation plan

Osteoarthritis Chronic Care Program Model of Care

Osteoarthritis Chronic Care Program Model of Care

See the ACI resources on the Model

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References

  1. Arthritis Australia, Counting the cost: Part 1 Healthcare costs. 2016: Sydney, Australia.
  2. Australian Institute of Health & Welfare. How does osteoarthritis affect quality of life? Risk factor, disease and death 2017 [cited 2017; Available from: http://www.aihw.gov.au/osteoarthritis/quality-of-life/.
Last updated: 26 Sep 2019

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Contact

Julia Thompson
Network Manager, ACI Musculoskeletal Network
02 9464 4672
julia.thompson2@health.nsw.gov.au