This was an innovation project supported by the Better Care Victoria Innovation Fund.
St Vincent’s Hospital Melbourne
- North West Metropolitan Primary Health Network
- Merri Health
Osteoarthritis (OA) can have an enormous impact on quality of life, psychological distress and work disability. In 2016, OA was a leading cause of pain and disability in Australia and was one of the most common conditions managed in general practice.
General practitioners (GPs) at times recommend surgery to treat OA over non-surgical management options such as physiotherapy, changes in diet, and counselling, advice and education. This can sometimes lead to patients being inappropriately referred to an orthopaedic surgeon.
High demand for specialist clinics for non-urgent patients and limited access to these services in the community contributes to long delays in accessing care, which can negatively impact a patient’s condition. Inappropriate referral, not based on standardised guidelines, can result in a patient having surgery with little benefit.
St Vincent’s Hospital Melbourne trialled a community-based clinic to assess and support patients with osteoarthritis of the knee. The project aimed to increase capacity for musculoskeletal management in the community to improve patient outcomes by providing more timely access for patients in need of joint replacement surgery and/or offering non-surgical management options where appropriate.
- Improve access to appropriate care in the community for patients with OA
- Use outcome measures and guidelines to increase consistency in the assessment of surgical and non-surgical treatment recommendations
- Support the uptake of non-surgical treatment when appropriate
- Demonstrated that a community-based multidisciplinary specialist clinic can deliver:
- a high uptake of ongoing therapy (84 per cent)
- a low (12 per cent) referral rate to surgery
- a high patient discharge rate from a clinic to the care of a GP
- Achieved patient satisfaction levels comparable to similar hospital-based clinics
- Achieved high satisfaction ratings of the service from GPs
- Developed and tested the use of the ‘SMART tool’, a decision aid that converts evidence-based outcome measures into a numeric score to determine the likelihood a patient will not respond, with self-reported improvement in function, to total joint replacement surgery
February 2018 – The Medicare Benefits Scheme funding model trialled as part of the project proved unsuccessful and the community-based clinic could not be sustained. However, several health services in Victoria and across Australia have contacted the project team to gain insight into the project and an understanding of how they may develop a similar model of care. The project has also had a lasting positive impact for St Vincent's Hospital Melbourne through the development of beneficial partnerships with North Western Melbourne Primary Health Network and Merri Health.
Project summary references
- Ackerman IN, Bucknill A, Page RS, et al. The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 2015;23:1276-84
- Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2012;20(10):1095-102
- Dowsey MM, Nikpour M, Dieppe P, Choong PF. Associations between pre-operative radiographic osteoarthritis severity and pain and function after total hip replacement: Radiographic OA severity predicts function after THR. Clinical rheumatology. 2016;35(1):183-9
- Baker P, et al. The role of pain and function in determining patient satisfaction after TKR. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br.2007;89(7)
- Wylde V, et al. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152(3)