Implementing a Better Model of Care for Chronic Osteoarthritis

Without more cost-effective interventions, increasing rates of chronic disease are projected to overwhelm the resources of health services.

One such threat to health system sustainability is osteoarthritis (OA), which affects one-in-eight Australians and is the leading cause of premature retirement. Surgery for osteoarthritic hips and knees is costing the national health system at least $4 billion per annum, and is rising by ten per cent a year.

In 2018 NSW Health began the state-wide roll out of an evidence-based Osteoarthritis Chronic Care Program (OACCP), which prioritises the treatment of OA with education, self-management, diet and exercise, before resorting to a surgeon’s knife. Sydney Health Partners supported the innovation by funding a research project called OAChangeMap, which sought to understand the enablers and barriers to the implementation of the model of care and pilot an intervention to enhance its implementation in NSW hospitals.

Chief investigator, University of Sydney Professor David Hunter, says a survey by his team found considerable variation in the way OACCP had been implemented across the state.

“At some sites, they had a physiotherapist but they didn’t have a dietician; at others, they had a social worker and a psychologist but they didn’t have a physiotherapist. In addition, the level of clinician’s training in the delivery of the new model of care varied dramatically. What we are trying to do is understand why that is the case.”

Currently, about 80 per cent of people with OA are given a prescription for analgesic medication and, if pain relief doesn’t work, are sent to an orthopaedic surgeon for consideration of joint replacement.

In 2011 Professor Hunter led a pilot of the new diet and exercise model. He found that 15 per cent of patients waiting for surgery had their OA symptoms reduced to such an extent they volunteered to be taken off the waiting list. NSW Health found that for every dollar they spent on the OACCP they saved five dollars in joint replacements.

Despite the compelling evidence, Professor Hunter says changing established OA treatment pathways takes time.

“In an ideal world, General Practitioners would refer the patients straight to OACCP. In a lot of locations, however, the orthopaedic surgeons would prefer to see the patients first,” he said.

“But there aren’t enough surgeons and patients can sometimes wait up to two years to see one. Even when they do receive surgery, one-in-four patients will not have a good outcome. So it’s not an approach that is adequately addressing the public health needs of a disease which affects three million Australians.”

The OAChangeMap project plans to develop a systems-level implementation plan for OACCP including education and training and pilot it at the Sydney and Northern Sydney Local Health Districts.

“To us, it appears that a key to implementing OACCP is providing enough education on its benefits to secure stakeholder engagement at all levels – from the chief executive of the local health district down to the on-the-ground support staff,” said Professor Hunter.

“Health services are realising that having a vast tome of information about a new model of care and a manual of procedures doesn’t make it easy to implement. And that’s why OAChangeMap is really important.”