Op0003 task-Shifting in Hand-Osteoarthritis Care

Abstract

BackgroundHand-osteoarthritis (HOA) is a prevalent rheumatic joint disease that significantly reduces quality of life. In Norway, HOA should mainly be managed in primary care, but patients often have insufficient access to recommended treatment options there and are instead frequently referred to rheumatologists. This leads to high healthcare costs and reduces the access to rheumatologists for patients with inflammatory rheumatic diseases, for whom early diagnosis, disease modifying medication and tight controls may induce remission and prevent irreversible joint damage and long-term disability. Delegating the healthcare management and treatment of HOA to allied health professions such as occupational therapists may therefore free scarce healthcare resources and improve overall health economics.ObjectivesIn this study we evaluated a new model of care in specialist healthcare, where HOA patients receive their first consultation by occupational therapists instead of rheumatologists. The objective was to test the non-inferiority of occupational therapist-led care (OTC) compared to rheumatologist-led care (RC) with regards to effectiveness defined as proportion of responders (based on OMERACT/OARSI criteria) and safety. In addition, we conducted a health economics evaluation comparing Quality-adjusted life years (QUALYs) and treatment costs between the treatment groups and conducted a cost-economics analysis.MethodsWe conducted a randomized controlled multicentre parallel group trial in which we recruited 400 patients with symptomatic HOA and no signs of possible inflammatory rheumatic disease at two Norwegian hospitals. Participants were randomized (1:1, computer-based) to either OTC (n=200) or RC (n=200). Various demographic and clinical parameters were registered at baseline. Disease activity (numeric rating scale, NRS, 0-10, 0=no disease activity), pain (NRS, 0-10, 0=no pain) and function (using the MAP-hand questionnaire, 18 items averaged to a 1-4 score, 1=no problems) were registered at baseline and 6 months post-intervention, and the delta was used to determine if patients were responders/non-responders based on OMERACT/OARSI criteria. Chi2-test and logistic regression were used to compare the proportion of responders/non-responder per treatment arm, and to analyse the relationship between response status (as dependent variable) and treatment arm (as independent variables). Results of the logistic regression are presented as odds ratio (OR) with 95% confidence interval (CI). Safety analysis was conducted by screening healthcare journals 12 months post-baseline for new diagnoses and adverse events related to musculoskeletal diseases. QUALYs were calculated using data from EQ-5D weighted with preference weights from the general population. To evaluate cost-effectiveness, we calculated and compared the incremental cost-effectiveness ratio (ICER).ResultsMean age was 63.6 years (SD=10.01), 80.8 % were female. No statistical difference between the treatment arms was found in any baseline variables. In the RC group, 48 patients (25.8%) met the primary outcome criteria for treatment response. In the OTC group, also 48 (25.4%) were classified as responders. The proportion of responders did not differ by treatment group (X2 (1, N = 337) = 0.0012, p =.97). Treatment group did not significantly predict response status (OR=0.99, CI=0.62-1.59, p = 0.97). No notable safety-related events were found in either group. No statistically significant differences were found regarding QUALYs and overall treatment costs, and cost-effectiveness was marginal.ConclusionWe found no statistically significant difference regarding proportion of treatment responders between the two treatment arms, suggesting non-inferiority of OTC compared to RC with regards to effectiveness and safety. While the cost-effectiveness analysis showed no clear benefit for either of the treatment options, delegating HOA treatment to OTs may free RT time and improve healthcare accessibility for urgent diagnoses, and thus prove a valuable opportunity to optimize future healthcare allocation.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Lessons learned from the PICASSO trial regarding ultrasound examinations of osteoarthritic hand joints performed by occupational therapists

“…Task shifting from rheumatologists to occupational therapists is increasingly common, and osteoarthritis care led by occupational therapists has shown to not be non-inferior to rheumatologist-led care 12 . Ultrasound may also be a valuable tool in clinical practice for occupational therapists in order to not only confirm the osteoarthritis diagnosis, but also determine the degree of synovial inflammation.…”