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

Artrose er en svært vanlig leddsykdom som rammer en stor del av den voksne befolkningen.Tidligere forskning har vist at behandlingen som gis til personer med artrose i Norge bare delvis gjenspeiler behandlingsanbefalingene i internasjonale retningslinjer. Et økende antall personer henvises for vurdering av proteseoperasjon, men mange av disse har ikke først forsøkt anbefalt behandling (trening, vektreduksjon, smertestillende medikamenter). Modellen innebar et tettere samarbeid mellom fastleger, fysioterapeuter og ortopeder og at internasjonale behandlingsanbefalinger ble kjent og tatt i bruk. Studien startet i januar 2015, og ved mars 2016 var behandlingsmodellen innført i alle 6 kommunene på Øvre Romerike. Tilsammmen har 40 fastleger og 37 fysioterapeuter deltatt på workshop om anbefalt behandling for personer med artrose. Denne studien viste at en ny behandlingsmodell i kommunehelsetjenesten resulterte i bedre kvalitet på behandlingen og noe bedre helseutfall for personer med hofte og/eller kneartrose. Videre skal studien undersøke om modellen har reduserert uønskede hendelser (f.eks unødvendige henvisninger til kostbare undersøkelser i spesialisthelsetjenesten, bruk av tiltak som ikke har dokumentert effekt). Datainnsamlingen ble avsluttet 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).