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by Dr. Joshua Tepper

Osteoarthritis: Be aware of a better care option

Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability.

With an estimated 5.6 million Canadians suffering from osteoarthritis and that number expected to increase significantly as the population ages, the condition still has no cure and can be difficult to manage effectively. In Ontario, people with osteoarthritis report a quality of life 10% to 25% lower than those without osteoarthritis, and they incur health care costs two to three times higher. Despite the seriousness of this situation, osteoarthritis is often underdiagnosed and undertreated.

Osteoarthritis is just one of several musculoskeletal conditions that affects one in three Ontario adults. Recently released wait-time data that can be found on the Health Quality Ontario website shows that patients with these conditions spend the most time waiting to access health-care services, like magnetic resonance imaging (MRI) even though that may not be the best treatment option. In addition, uncontrolled knee, hip and back pain has been associated with inappropriate use of opioids.

To address this, an approach to redesign and innovate the current model of care in Ontario will help people access the right treatment faster, starting with osteoarthritis and other conditions causing hip, knee and low-back pain.

This approach involves primary care providers referring patients through a central intake and referral centre to a Rapid Access Clinic where they will be assessed quickly (within 4 weeks) by an Advanced Practice Provider (usually a physiotherapist, chiropractor or nurse practitioner with advanced skills and training).

Those patients requiring a surgeon consultation are offered the next available appointment or the opportunity to choose an appointment with their preferred surgeon. Patients not requiring surgery are given an individualized self-management plan co-developed by the patient and the Advanced Practice Provider, supported and monitored by the patient’s primary-care provider. The patient may also be connected with additional health-care supports in their community.

An evaluation of this model of care in seven regions of the province found both patients and health care providers were highly satisfied with the approach and surgeons also reported benefits from the use of Advanced Practice Providers enabled them to spend more time with patients with complex problems, and less time assessing patients who did not need surgery.

Benefits for patients include:

  • Spending less time waiting to determine their best treatment options.
  • For those that need a surgical consultation, being able to choose the ‘first available surgeon’.
  • Education and self-management support for those who don’t require a surgeon consult.

Patients particularly value the additional time with the Advanced Practice Provider during the assessment, which incorporates education as a structured element.

For referring clinicians, the benefits of the approach include:

  • The ability to access an assessment within 30 days of referral.
  • Being able to more quickly connect their patients to other services or emphasize self- management to their patients when surgery is not indicated.
  • Reducing the management of patients on multiple waiting lists.

For surgeons, the benefits include:

  • When they see their patients for the first time, they come with appropriate work-up and x-rays.
  • Fewer surgical delays and cancellations.

Implementing Rapid Access Clinics has been supported by ARTIC (Adopting Research to Improve Care), a joint program of Health Quality Ontario and the Council of Academic Hospitals of Ontario. ARTIC’s focus is accelerating the spread of proven care. It is anticipated the clinics will be available throughout the province by the end of this fiscal year.

To learn more about the program visit our website or join the musculoskeletal community of practice on Quorum.

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