Whole person journey approach to OA

Professor David Hunter

Professor David Hunter

A draft National Osteoarthritis Strategy has set a broad range of targets to help prevent and appropriately manage Australia’s most common chronic joint disease.

The Strategy includes community level targets such as increasing physical activity levels by 15% by 2030 and reducing sports-related knee injuries by 25% by 2025 to help prevent osteoarthritis.

It also calls for at least 50% of people with osteoarthritis to be undertaking lifestyle and other self-management strategies to reduce pain and disability by 2025.

The Strategy, endorsed by Arthritis Australia, the Australian Rheumatology Association (ARA), the Australian Orthopaedic Association and the Australasian College of Sport and Exercise Physicians, underpins the agenda at the upcoming 2018 Osteoarthritis Summit in Canberra (Tuesday, 27 November).

Professor David Hunter, Chair of the Institute of Bone and Joint Research at the University of Sydney, told the limbic the project group were hopeful for change at all levels.

“The strategy has three prongs and in an ideal world all would be implemented. Those prongs include prevention, targeting those who have disease with appropriate care and ensuring that the right person at the right time gets an operation. If we just tackle one of them it will obviously be an improvement over what we have now but ultimately will have shortcomings in other areas. It’s important that the breadth be covered.”

The Strategy calls for both Medicare and health insurance reform to provide adequate multidisciplinary support for issues such as weight loss and pain management.

For example, it encourages the Government to expand access to Medicare item numbers so patients can see allied health professionals beyond the current maximum of five sessions per year under the chronic disease management program.

“For the government that obviously rests around being economically favourable irrespective of the outcome for pain and function for those affected. From an economic perspective, we have demonstrated in New South Wales that for every dollar invested in these types of programs the health system can save around five dollars from joint replacement costs. This is through targeting appropriate patients and providing them with appropriate multidisciplinary care. It’s not complicated. To most people it is just common sense and ultimately if the government refuses to listen the tsunami of joint replacements will continue to escalate.”

The Strategy also calls for osteoarthritis management educators, skilled in both the physical and psychological domains, to assist patients with non-surgical management of the condition.

“The analogy to diabetes educators is a good one. These will be people who would be responsible for enhancing education and care coordination for people with osteoarthritis. More than likely they would be nurses or practice managers engaged at the primary care level where this should be happening,” Professor Hunter said.

Another priority area for implementation is better predictive tools for decision-making around surgery.

“In an ideal world a person would present to their GP and be provided a decision aid that would afford them information about options for interventions for their disease management and inform them about the pros and cons of these decisions so that the decision that they make with their GP can be well-informed.”

“For those that are late in the course of their disease, where surgery might be a suitable option, they would be provided information about the likely outcomes, costs, complications and the recovery period. In addition those with little if any radiographic change, little if any pain, those who are depressed or morbidly obese and by virtue of these factors more likely to have a poor outcome following surgery, would be afforded different intervention options or at least information about the likely outcome of their surgery.”

Professor Hunter said community education was also critical.

“Unfortunately the common community perception is that surgery is inevitable. The overwhelming majority of people (~90%) with osteoarthritis never require a surgical intervention. Changing public awareness and perception of this will require extensive education not only of consumers but also of the health professionals who often instigate the statements in the first place.”

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