THU0647-HPR Improving Access To A Better Model of Care for People with Knee and Hip Pain in Primary Care - The Osteoarthritis Advisor
Authors: M. Hurley, A. Walker, F. Sibley, A. Carter, D. Stamp, S. Thakar, M. Creasey, R. Williams
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Primary care management of osteoarthritis (OA)is often sub-optimal<sup>1</sup> because physicians feel overwhelmed by patient numbers and don9t have time or skills to deliver lifestyle advice effectively – information, self-management, physical activity, weight control<sup>2</sup>. Allied healthcare professionals (AHPs) are better skilled in delivering lifestyle coaching. Although AHP-led care is common in many chronic conditions, it is still uncommon in primary care management of OA. <h3>Objectives</h3> We placed an AHP in the primary care pathway to improve access of more people, and to assess if AHP-led primary care was feasible, safe, effective and valued. <h3>Methods</h3> In February 2015 a physiotherapist began running clinics for people with knee/hip OA in a primary care surgery. At an initial assessment (∼30 minutes) the <i>Advisor;</i> –assessed their pain and function, physical activity level, waist circumference, body mass –taught the effective self-management strategies - weight control, exercise, pain management –used behavioural change techniques - motivational interviewing, set SMART goals, action/coping plans, monitoring, feedback –help construct personalised care plans –identified people9s physical activity preferences (swimming, walking) and identified local availability –referred to relevant agencies (dietician) if necessary Patients were invited to return for review (30 mins) 6 weeks later when the <i>Advisor</i>; –repeated the outcome measures –feedback progress and success –reinforced health messages –offered on-going support, reassurance and encouragement Qualitative interviews assessed people9s opinions of the effectiveness and value. <h3>Results</h3> 117 patients were recruited. Initially people were not receiving recommended advice and support. Between the initial assessment and the 6-week follow-up improvements were seen across <i>all</i> outcomes: - Knee/Hip Osteoarthritis Outcome Score improved - pain 16%; function 17%; quality of life 15% –waist circumference decreased by 1.8cm –weight decreased by 0.8kg –physical activity increased by 2.1 days walking 20min per week –patients were able to do on average 5.6 more “sit-to-stands” in 30 seconds Patient satisfaction was very high. they valued advice tailored to their individual needs, appreciated easier access to care, the convenience and familiarity of the service being in their local GP surgery. This translated into self-reported improvements; <i>“…it worked…I got a big improvement…”</i> <i>“…from February to April I wasn9t walking, now I can…”</i> <i>“…I was 10 stone and went down to 9 stone…”</i> Staff satisfaction was also very positive and interest from neighbouring practices meant the role was adopted by 4 other surgeries. <h3>Conclusions</h3> AHP-led care of people with knee/hip OA is feasible, safe, quickly accepted and implements evidence-based guidelines care management recommendations that improves important clinical outcomes. Patients, GPs and other practice staff liked and wanted the service. <h3>References</h3> Ganz, et al. Arthritis Rheum (2006) 55:241–7. Cottrell et al. BMC Family Practice (2010) 11:4. <h3>Acknowledgement</h3> The project was funded by the Health Innovation Network South London. <h3>Disclosure of Interest</h3> None declared