Improved management of patients with hip and knee osteoarthritis in primary health care

Osteoarthritis is a very common joint disease among the adult population. Previous research has shown that people with osteoarthritis in Norway do not necessary receive the treatment recommended in international guidelines for osteoarthritis care. An increasing number of people are referred to assessment of surgical treatment, but many have not tried a period with recommended core treatment (exercise, weight reduction and pharmacological treatment) first. The model facilitated an increased collaboration between general practitioners, physiotherapists and orthopaedic surgeons and included an implementation of international treatment guidelines for osteoarthritis. The study started in January 2015, and by March 2016 the treatment model had been implemented in all 6 municipalities in Øvre Romerike. All in all 40 general practitioners and 37 physiotherapists have participated in workshops on recommended osteoarthritis treatment for people with osteoarthritis. This study showed that a new model for treatment in primary health care resulted in better quality of care and somewhat improved health among people with hip and/or knee osteoarthritis. The study will further analyse if the model have reduced the use of treatment modalities that are not evidence based or referrals (in example unnecessary referrals to costly examinations in secondary care, use of treatment modalities with no documented effect). The data collection was finished in September 2017.

Current political documents recommend that patients with osteoarthritis should mainly be managed in primary health care. However, recent Norwegian research indicated that the quality of primary health care services is sub-optimal for this patient group. T his application presents a collaborative project between six municipalities at Øvre Romerike, Akershus University Hospital, the University of Oslo, and Diakonhjemmet Hospital, aiming to fulfil the intentions of the Coordination Reform. A model for integra ted care among persons with hip and knee osteoarthritis and a training package for the health care professionals will be developed and implemented. The model includes adaption of evidence based international recommendations for osteoarthritis care provide d by general practitioners and health professionals at Frisklivssentraler in the primary health care services. Further, the model includes collaboration between primary health care professionals and across health care levels to ensure that persons with os teoarthritis will experience timely, well integrated, and high quality care. The model intends to improve professional practice and patient outcomes, and reduce non-desired events (e.g. unnecessary referrals to secondary care, unnecessary use of costly im aging modalities, use of treatment modalities supported by low quality of evidence), and will be evaluated in a stepped wedge cluster randomized controlled trial. The model will meet the current need for a multidisciplinary approach to manage patients w ith chronic diseases and strengthen the health care services through collaboration while keeping the patient in focus. As different chronic diseases share several aspects in relation to health care management, this model may easily be transferred to also comprise other chronic diseases (i.e. diabetes, chronic obstructive pulmonary disease, chronic musculoskeletal pain).