The main goal of this project is to develop a novel, safe and feasible care pathway for patients with hand osteoarthritis (HOA). In the first phase of the project, we evaluate if occupational therapist-led care is as safe, effective and cost-effective as rheumatologist-led care for patients with hand osteoarthritis in a randomised controlled non-inferiority trial (RCT).
In the second phase, we interview patients with hand osteoarthritis and clinicians involved in osteoarthritis care to gain a better understanding of current health care pathways, and the context and determinants for shifting tasks between health care professions and levels.
Together with knowledge from previous research, the results from the first two phases will be used to develop a new health care pathway for patients with hand osteoarthritis. An expert group of patient representatives, rheumatologists, general practitioners, health care professionals and researchers will participate in a process with several voting rounds to reach consensus on a new care pathway and strategies to implement this pathway in to clinical practice.
When implemented, the new care path way will ensure better access to evidence based treatment for patients with osteoarthritis, who currently have little access to recommended treatment.
Further, the results concerning safety, facilitators and barriers for task shifting and needed experience and training may be relevant for task shifting in the care of other chronic diseases, thereby enhancing professional practice and cost-effective utilization of health care resources in the treatment of large patient groups.
Results from the RCT showed that the proportion of participants who met the criteria for treatment response did not differ by treatment group, suggesting non-inferiority of occupational therapist-led care compared to rheumatologist-led care with regards to effectiveness.
The findings from interviews with clinicians show a unanimous wish for HOA care to be shifted from rheumatologist to occupational therapists. Attitudes towards HOA as a diagnosis, interpersonal relationships between rheumatologist and occupational therapists, and knowledge are key facilitators and barriers affecting this process.
In the division of labour, patients highlight in interviews the importance of professional knowledge and skills within the field and interpersonal skills independent of professional background and levels of the health care system. They also underline few treatment opportunities beyond self- management resulting in task- shifting to service users.
Current political documents state that patients with OA should mainly be managed in primary health care. Still, research shows that patients with HOA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. At the same time, there is a shortage of rheumatologists and their time should primarily be allocated to patients with inflammatory rheumatic diseases, for whom early diagnosis, disease modifying medication and tight controls may induce remission and prevent irreversible joint damage and long-term disability. WHO argues that reorganizing the workforce by shifting tasks to less educated or specialized health care professionals is necessary to make more efficient use of the human resources currently available.
This application presents a collaborative project between 4 rheumatology centers across Norway, exploring how tasks may be shifted between professions and health care levels to develop an evidence-based, safe, and cost-effective care pathway for people with HOA.
In WP1 we will evaluate if occupational therapist-led care is as safe, effective and cost-effective as rheumatologist-led care for patients with HOA, in a non-inferiority RCT where 300 of a total of 400 participants already are included.
In WP2 we will interview patients and clinicians involved in HOA care to gain a full understanding of current HOA pathways, and the context and determinants for shifting tasks between professions and health care Levels.
In WP3 we will undertake a modified Delphi consensus exercise to develop a new HOA care pathway and strategies for implementation of the pathway.
The study has been developed in close collaboration with patient research partners, clinicians and international experts, who will also contribute in the process of integrating study results in clinical practice. The results may also be used to improve access to care for people with other chronic diseases.