Osteoarthritis chronic care program model of care - the need for change

A large prospective cohort study provided evidence that March 2009, suggests suboptimal use of al ied health approximately 70% of knee replacements are associated practitioner interventions to support effective lifestyle with, or attributed to, excess weight [11]. Further, it has and behaviour changes for exercise and weight loss been estimated that if all overweight and obese people [14]. Over the five year study period, only 3.9% of OA reduced their weight by 5kg, or to within the normal encounters were referred for al ied health intervention, body mass index (BMI) range, approximately 25-50% of which 81.7% were referrals to physiotherapy, 3.3% of all knee replacements could be avoided [12]. Despite were to hydrotherapy, and 0.8% to a dietitian. Where this information, fewer than 8% of Australians reported knee OA was a new problem, 5.5% were referred to trying to lose weight as part of their OA treatment [13].
A recent analysis of the BEACH (Bettering the Evaluation Case studies 1 and 2 reflect examples of osteoarthritis and Care of Health) survey report, from April 2004 to management currently offered in primary care.
CASE STUDY 1: Rosie
been loath to prescribe any medication besides paracetamol for her arthritic pain. While her GP and other health professionals had advised her to take daily walks to manage her diabetes and heart problems, she could not tolerate the resultant knee pain. This has resulted in her weight increasing further and her blood pressure becoming difficult to manage despite her medications.
recently, rosie went to see her GP after a four day history of increased knee pain and swel ing. On examining rosie, her GP noted she had recently put on more weight and her body mass index (BMI) was now 35. The general examinations, which included respiratory, cardiac and abdominal rosie is a 64 year old lady who has a long history examinations, were normal, although her blood of painful knees which have significantly limited her pressure was 165/95. While there was documentation day to day activities for the past three to four years. of her temperature, skin condition and initial She paces her household chores and is frustrated laboratory studies, there was no record of rosie’s that her interactions with her four grandchildren are limited. She used to take them to the local park on a Despite her co-morbidities, rosie’s GP reluctantly regular basis but the pain now is such that she cannot prescribed an anti-inflammatory. rosie is advised tolerate even a short period of activity with them.
to go home and rest. She is given no advice about unfortunately, this has not helped her manage her OA, its relationship to being overweight, nor its hypertension and diabetes, and a year ago, she presented to the local hospital with angina. This morbidities. She is advised that if her pain does not resulted in her having a stent to her right coronary settle within two to three months she will be referred artery and now she has to take aspirin, perindopril to an orthopaedic surgeon to talk about a possible and atorvastatin. Since that time, her GP has ACI Musculoskeletal Network – Osteoarthritis Chronic Care Program Model of Care 11
CASE STUDY 2: Frank
He has been an avid golfer and gardener all his life, and has enjoyed playing golf three times a week since he retired. Over the last three months, Frank has been playing golf just once a week due to pain in both his hip and one knee. He also feels it is much more difficult to tend to his lawns and garden, as what starts as a little pain in his hip at the beginning of the day develops into quite a great deal of pain after mowing his lawn.
Frank saw his GP, a friend from the golf club, a year ago and his GP recommended Frank continue playing golf, but instead of walking, he could consider using a golf cart. His other mates at the golf club swear by a heat-inducing arthritic cream before and after golf, and they suggest he give it a try.
Despite taking up these suggestions, Frank’s hip pain continued to worsen. He returned to his GP who referred him to an orthopaedic specialist. Frank is 70 years of age and presented to his GP The specialist confirmed that Frank had OA of both with a two year history of left hip and right knee his hips and one of his knees and he would require pain with activity. He complains of intermittent replacement of his hip and knee joints. Frank is buckling of his right knee and an inability to play currently on the waiting list for surgery and has his golf regularly. His left hip aches at night, and had to give up golf as he was unable to deal with after sport he tends to limp due to the pain. 12 ACI Musculoskeletal Network – Osteoarthritis Chronic Care Program Model of Care

Source: http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0017/165320/Need-for-Change.pdf