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 . Further, it has
and behaviour changes for exercise and weight loss
been estimated that if all overweight and obese people
. 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 . 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 .
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.
ACI Musculoskeletal Network – Osteoarthritis Chronic Care Program Model of Care
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