A ‘joint’ approach: design, implementation and preliminary outcomes of an early conservative knee and hip osteoarthritis service in northern New South Wales, Australia

Abstract

Australia is facing a growing burden of knee and hip osteoarthritis (OA). To address this demand in northern New South Wales, a community health-based conservative OA joint management service was established in the Tweed Valley. This paper describes the design, implementation and initial evaluation of the service. Following the principles of clinical redesign, a diagnostic phase involving consultation with key stakeholders revealed several issues. OA patients could wait up to 9 months for review by orthopaedic specialist following GP referral and received limited information on how to conservatively manage their conditions. GPs were constrained by short consultations and had limited knowledge of the latest recommendations for the conservative treatment of OA. GPs also highlighted the limitations of outdated fax systems for communication, noting their preference for secure electronic messaging. Based on these findings, the Tweed Knee and Hip Arthritis Service was established. For patients not on a waiting list for surgery, the service provides evidence-based conservative management for knee or hip OA involving standardised assessment, education, exercise, self-management strategies and regular review. An analysis of a foundational cohort of patients demonstrated improvements in a suite of validated and standardised measures for pain and function, with improvements seen as early as 1 month and sustained for 6 months. The study findings support the introduction of integrated conservative OA management models of care directly available to primary healthcare providers.