Abstract

In Norway, as in many other countries, there is a need to develop integrated care and smooth collaboration between health care levels. A new health sector reform is recently initiated in Norway, “The Coordination Reform”, in which the main goal is that the patient should receive the proper treatment – at the right place and right time. According to the reform plan, patients with osteoarthritis (OA) should be treated in primary care. Secondary and specialised health care shall support primary care in developing care, exchanging competence, increasing competence and skills, and developing patient/treatment pathways.

So far, no treatment pathway has been developed for OA patients in Norway, and research on provision and quality of health care service for Norwegian OA patients is scarce. According to members of the Norwegian Rheumatism Association, the OA patients feel there is a lack of information and support given to them by health professionals, and they are dissatisfied by the service they receive. Normally, OA patients can consult their GP, and the GP may refer the OA patient to physiotherapy treatment in primary care or to assessments in secondary care, which may include rheumatologist, orthopaedic surgeon, physiotherapists, and/or occupation therapists. The patient must be referred to occupational therapists in secondary care for individual adjustments of hand splints, whereas primary care occupational therapists, although few, perform functional assessments in the patients homes when there exist a considerable functional loss. When an OA patient has reduced walking mobility or fall problems, the GP may apply for a rehabilitation stay, which takes place in specialized rehabilitation centres or in rheumatology hospital departments. Surgical treatment in secondary care is the final option for severely affected OA patients. Treatments are reimbursed by the national welfare system except for a limited amount of “out-of-pocket” payment.

Researchers from The National Research Center for Rehabilitation in Rheumatology and Department of Rheumatology (NRRK) at Diakonhjemmet Hospital have, together with researchers from Orthopaedic Section at Oslo University Hospital and University of Oslo, initiated an osteoarthritis project in collaboration with the primary health care services in Ullensaker Municipality, about 40km north-east of Oslo. The project, The Musculoskeletal Pain in Ullensaker Study (MUST), focuses on OA and includes epidemiological, clinical research, randomised controlled trials, competence exchange and development as well as OA care development. However, collaborations across the borders of health service levels may often be challenging. Experiences from this project and future plans for a couple of other Norwegian projects will be given.