Implementation of an Osteoarthritis Hip and Knee Service (OAHKS) in a community health setting compared to the hospital setting: a feasibility study for a new care pathway

Ms Alison Gibbs2,3,4, Professor Nicholas Taylor1,3, Ms Leanne Roddy1, Ms Kylie Durant2, Dr Christopher Fong1, Mr Raphael Hau1, Ms Leanne De Vos2, Dr Jason Wallis1,3

1Eastern Health, Box Hill, Australia, 2Access Health and Community, Doncaster, Australia, 3La Trobe University, Bundoora, Australia, 4Monash Health, Clayton, Australia

Abstract: 

Aim: OAHKS involves the substitution of an orthopaedic surgeon with an advanced musculoskeletal physiotherapist, to assess patients with hip and knee osteoarthritis referred from primary to tertiary care. We examined whether implementing a community-based OAHKS was feasible; and compared results with a hospital-based OAHKS.

Method: We explored feasibility in terms of acceptability (patient, general practitioner and orthopaedic surgeon satisfaction), demand (referral numbers, waiting times), efficacy potential (OAHKS management decisions, conversion-to-surgery rates) and practicality (number and type of conversations between OAHKS physiotherapist and doctors, adverse events) of a community-based OAHKS compared to a hospital-based OAHKS.

Results: From 91 patients attending OAHKS (40 community-based, 51 hospital-based), the community OAHKS setting had high satisfaction levels with patients and general practitioners, short waiting times for initial assessment [mean 17 days (SD 11)], short waiting times to begin non-surgical management [mean 32 days (SD 22)], with a much lower referral rate to orthopaedics [odds ratio 0.05 (95% CI 0.01 to 0.41)] compared to the hospital-based OAHKS. There were no adverse events.

Significance of the findings to allied health: In this pilot study it was feasible to provide an OAHKS clinic in a community health setting led by an advanced musculoskeletal physiotherapist. While these results are encouraging, future research could establish if this community-based OAHKS can have an impact on hospital waiting times and patient outcomes.

Biography: 

Alison Gibbs is an advanced musculoskeletal physiotherapist and an emerging researcher.