Primary care, although varying between countries, is where most health care for osteoarthritis (OA) is provided in the context of peripheral joint pain in older adults. Education and self-management are specific recommendations of all clinical guidelines for OA. Self-management programs, either individually or in groups, should emphasize the recommended core treatments for people with osteoarthritis, especially exercise. The challenge for primary care is to preserve the advantages of the medical model, whilst encouraging a shift of perspective towards a model of care, which addresses biopsychosocial factors associated with the development of chronicity. As a consequence, questions have been raised about the need for new models of primary care to better support effective osteoarthritis self-management. The multidisciplinary team has been shown to be effective in optimising management of patients with arthritis in secondary care, however, evidence for such approaches in primary care is limited. Crucially, the most important member of the multidisciplinary team is the patient as an expert in living with the condition. Many patients accept the need and attraction of self-management but say they need help from health professionals to achieve it. This has contributed to the idea of self-management needing to be strongly supported by health professional involvement in chronic disease programs, including joint pain.
Allied health professionals have been trained in approaches that consider the multidimensional interactions of a person with OA and their psychological, social and environmental needs. With limited resources a practice nurse working alongside the General Practitioner (GP) could provide the first level of care, with appropriate training, to give high-quality advice and monitoring and to know when to refer the patient. Core treatments in the management of osteoarthritis include weight loss and exercise. These are complex interventions where the health care practitioner has to be skilled at guiding patients in self-management. Simply giving a leaflet or showing someone quadriceps exercises will not be sufficient.
We conducted consensus exercises with GPs, lay participants, practice nurses and allied health professionals (occupational therapists, physiotherapists, podiatrists, community pharmacists) to identify the content of model OA consultations. Three linked consultations were proposed; with a GP (initial visit), a practice nurse (follow-up visits and review) and opportunistic consultations the wider multidisciplinary team. We are now studying how best to implement this model consultation for OA in primary care. We have adopted the WISE model (“Whole system Informing Self-management Engagement”)1. A whole systems approach envisages informed patients receiving support and guidance from those trained practitioners who are working within a healthcare system which is geared up to be responsive to patients’ needs.
The talk will illustrate how the multidisciplinary team has a key role to play in patient-centred support for self-management of OA in primary care.
Kennedy AP, Rogers AE, Bower P, Support for self care for patients with chronic disease BMJ 2007;335:968-970.
Disclosure of Interest None Declared
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