A group of academics is calling for coordinated osteoarthritis management and care to be recognised as a priority in New Zealand and delivered nationwide.

The group, which includes Arthritis New Zealand President Peter Larmer, says a model of care for osteoarthritis would save money and improve quality of life for many. Rather than waiting for expensive surgery, patients could be informed about other options and actively involved in their management, including exercise, diet and pain-relief.

At present, osteoarthritis care is fragmented, with little collaboration between health providers and a lack of regional consistency. The Ministry of Health’s Mobility Action Programme (MAP) is a step in the right direction by funding support programmes in local communities for people with long-term musculoskeletal conditions. While yet to be evaluated, MAP could be upscaled to form the basis of a more effective model of osteoarthritis care that focuses on collaboration and prevention.

The case studies below highlight the benefits of such a system. Agnes and Bill are not real people but they both have osteoarthritis. Agnes’ story is typical of how the condition is treated and managed under our current health system. Bill’s experience is what could happen if a comprehensive model of care for osteoarthritis was adopted in New Zealand.

Agnes: The current system

Agnes, 66, has knee pain which has been getting worse in the last 12 months. She now has trouble walking up and down stairs and doing household chores. Since she retired she’s been caring for her young grandchildren two days a week while her daughter works, but lately this has become difficult. She stopped playing social tennis several months ago and hasn’t been getting out to visit her friends. As a result, she is becoming more isolated and is showing signs of depression.

Agnes saw her GP six months ago, when an X-ray showed she had moderate osteoarthritis in both knees. Her weight gain means she is now classified as obese. The GP prescribed pain-relieving medication and anti-inflammatories. She also talked to Agnes about weight-loss and exercise but did not refer Agnes to any other health professionals.

Agnes may have to wait six months to see an orthopaedic surgeon. She feels that, soon, she won’t be able to care for her grandchildren. Agnes is very anxious and feels her quality of life is deteriorating.

Bill: With a model of care in place

Bill is 61 years old. The pain in his left hip is getting worse and he limps quite badly, especially on busy days. He took up jogging to try and lose weight but stopped when exercise made the pain worse. He works part-time but fears he may have to retire earlier than planned.

A physiotherapist assessed Bill thoroughly and told him he might have osteoarthritis; an X-ray ordered by his GP confirmed this diagnosis. The physiotherapist then suggested a programme that would help Bill manage his symptoms. They developed a care plan together and discussed options apart from surgery and drugs.

Bill joined an exercise group to focus on strengthening his hip. He was referred to a pharmacist for pain medication, a physiologist for a general exercise plan, and a dietician for advice on healthy eating. Bill was happy to hear that all these services would be partially funded by his local district health board.

Six weeks on, Bill can walk for half an hour three times a week, mostly without limping. He has lost 3kg and feels healthier and stronger. Since he’s happy with his progress, he’s decided not to see an orthopaedic surgeon for now. Bill feels able to continue his exercise and diet regime on his own, confident that good advice and care is at hand if he needs it.

Source: Jennifer Baldwin, Andrew Briggs, Warwick Bagg and Peter Larmer, ‘An osteoarthritis model of care should be a national priority for New Zealand’, The New Zealand Medical Journal, 15 December 2017, Volume 130 Number 1467.



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