Background Primary care management of osteoarthritis (OA)is often sub-optimal1 because physicians feel overwhelmed by patient numbers and don't have time or skills to deliver lifestyle advice effectively – information, self-management, physical activity, weight control2. 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.
Objectives 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.
Methods 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 Advisor;
– 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 people's 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 Advisor;
– repeated the outcome measures
– feedback progress and success
– reinforced health messages
– offered on-going support, reassurance and encouragement
Qualitative interviews assessed people's opinions of the effectiveness and value.
Results 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 all 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;
“…it worked…I got a big improvement…”
“…from February to April I wasn't walking, now I can…”
“…I was 10 stone and went down to 9 stone…”
Staff satisfaction was also very positive and interest from neighbouring practices meant the role was adopted by 4 other surgeries.
Conclusions 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.
Ganz, et al. Arthritis Rheum (2006) 55:241–7.
Cottrell et al. BMC Family Practice (2010) 11:4.
Acknowledgement The project was funded by the Health Innovation Network South London.
Disclosure of Interest None declared
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