AN OSTEOARTHRITIS CARE INTERVENTION CO-ORDINATED BY A PHYSICAL THERAPIST AND A CLINICAL NURSE SPECIALIST: A FEASIBILITY STUDY

Background: Some of the patients with osteoarthritis (OA) who are referred to an orthopedic surgeon or rheumatologist do not require further specialist care. Nevertheless, their referral may in some cases result in multiple hospital visits and insufficient communication with the general practitioner (GP). Objectives: To evaluate the feasibility of a single-visit multidisciplinary, standardized care intervention including assessment, treatment recommendations and aftercare. Methods: The intervention consisted of a single, standardized outpatient clinic visit preceded by the gathering of information on the patient's socio-demographic and clinical characteristics by means of questionnaires and chart review. The visit included an assessment (history taking, physical examination, X-rays and blood tests), followed by a tailored management advice, to be executed in primary care. Its content and logistics were based on (inter-)national guidelines of OA-management and focus group interviews with GPs. The intervention was provided by a physical therapist and clinical nurse specialist (co-ordinators) and orthopedic surgeon or rheumatologist. A comprehensive report was sent to the GP within 1 week. After 6 weeks the clinical nurse specialist contacted the patient to monitor the treatment advices. Feasibility was evaluated by means of a registration of the number and nature of the treatment advices and a multidimensional patient satisfaction questionnaire including: focus on treatment demand, provision of information, expertise of the staff and an overall rating (0-10) 3 months after the visit. Results: Twenty consecutive patients referred to the outpatient clinics of the departments of rheumatology or orthopedics of a university hospital were considered eligible for the care program based on the referral information. Thirteen (65%) were female, median age 64 years (range 41-83). The localization of complaints included the hands (n=3), knee (n=5), hip (n=5) or multiple sites (n=7). Fifteen patients received a treatment advice and were referred back to the GP, whereas 5 patients were found to be in need of further specialist care (1 requiring further diagnostic tests, 2 requiring surgery and 2 requiring specialist follow-up). Treatment advices to the 15 patients pertained to: coping with the consequences of OA (n=15), optimization of self-management (n=13), physical therapy referral (n=13), assistive devices (n=9) and adjustment of medication (n=7).Ninety-eight percent of the patients was satisfied about the focus on treatment demand, 88% about the provision of information, and 94% about the staff's expertise. The overall satisfaction score was 8.4. Conclusions: A single-visit multidisciplinary OA management intervention co-ordinated by a physical therapist and a clinical nurse specialist was feasible in 75% of patients referred to a medical specialist who were pre-selected based on referral information. The number of treatment advices given and high satisfaction scores substantiate the added value of the intervention and justify a further evaluation of its cost-effectiveness. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 752Session: Miscellaneous forms of clinical care (Poster Presentations )