Osteoarthritis (OA), the most common form of arthritis, can be viewed as a chronic condition; however, it is seldom approached as such. Although risk factors for other chronic conditions, such as diabetes and heart disease, are generally screened for during a routine physical exam, OA is not.
The joint pain of OA is frequently perceived as an inevitable part of aging, so patients and healthcare providers tend to tolerate it until the condition has progressed to the point that joint replacement is accepted as the only treatment.
Toby King, executive director of the U.S. Bone and Joint Initiative, says “a number of executive board members thought the time was right to change the paradigm of OA care. To make it more proactive, than reactive.” He says it was a swift decision because this was an “issue that needed to addressed.”
A product of the Work Group was the Call to Action, advocating for a change in the paradigm of intervention (see http://www.usbji.org/sites/default/files/COAMI%20Call%20to%20action.pdf).
With little time devoted to education about OA, healthcare providers’ lack of awareness of the condition is a significant missed opportunity. Typically, there is no multidisciplinary approach to OA. There should be screening tools or questions tested in different settings. The Call to Action also states healthcare providers should have “basic tools to gauge levels of risk, disability, pain or loss of function.”
The Work Group also identified other actions to increase healthcare providers’ awareness of OA. They included:
- Convening an OA management conference that would, in part, “address the incomplete and inconsistent approaches to managing OA”;
- Reaching out to other partners for inclusion in future COAMI work, such as practitioners in weight management, nutrition and sports medicine;
- Exploring standardizing screening tools and indicators of OA to make early diagnosis more consistent and likely;
- Developing tools and prompts to engage patients in learning about and managing OA;
- Lending COAMI’s support to existing advocacy and awareness efforts; and
- Developing and supporting an OA-specific research agenda.
The Work Group was expanded in September 2013, and the Osteoarthritis Management Conference started developing a model of care. COAMI hopes to make early screening, detection, intervention, ongoing monitoring and comprehensive care models an integral part of medical care.
Joint Efforts
Joanne Jordan, MD, MPH, professor of medicine and orthopedics at University of North Carolina’s Thurston Arthritis Research Center and chief of the Division of Rheumatology at UNC, is the chair of COAMI. She characterized COAMI as an “organization of organizations of providers to move into proactive identification and assessment of osteoarthritis patients.”
Leigh F. Callahan, PhD, director of the Multidisciplinary Clinical Research Center’s Methodology Core at the Thurston Arthritis Research Center and member of the COAMI Steering Committee, says, “OAAA [Osteoarthritis Action Alliance] is excited about collaborating with COAMI to ensure the chronic model of care is disseminated as widely as possible.” COAMI’s mission fits with one of OAAA’s goals: “Mobilize health systems and health care professionals to proactively identify and comprehensively address OA in their clinical care” (e.g., decision prompts, pain management, physical activity as a vital sign, referral to community-based programs).
At a scheduled April COAMI meeting, which will be held in conjunction with the OAAA, the two organizations will find ways to “mesh and be synergistic,” says Dr. Jordan. The OAAA has similar goals to those of COAMI, but is directed more toward the public and healthcare policy. The two are a natural fit to come up with a strategic approach to dealing with OA.
“After the April meeting, we’ll start solidifying our long-term goals, start looking at plans to engage payers and create algorithms to guide primary care providers and others to identify patients,” Dr. Jordan says. “A visit planner will create an algorithm for how to deal with a patient from the time she enters the office.” Much useful information, such as BMI, lipid levels, hypertension, diabetes and osteoporosis, can be embedded in electronic medical records. Collecting information needs to become second nature to the healthcare provider.
Mr. King concedes that enticing primary care providers into the project may be “quite a challenge” because they are already overburdened, but their involvement is vital, so patients can be identified early.
The information in the electronic medical records can also be a great source of data for research, according to Dr. Jordan. “In the U.S., we’re kind of behind. Canada has been doing this kind of thing for years. All of us, including rheumatologists, need to be aware.”
Early Intervention Makes a Difference
For evidence that intervention, before joint replacement, does make a difference in OA patients’ lives, we can look to Denmark.
Ewa Roos, PT, PhD, physiotherapist, professor and research director at the Institute of Sports Science and Clinical Biomechanics at the University of Southern Denmark, created Good Life with Osteoarthritis in Denmark (GLA:D).
GLA:D introduced a targeted approach to teaching and training patients with knee and hip OA. During a two-day course, physiotherapists learn how to present information about OA treatment to patients. The patients enrolled in GLA:D take an eight-week course, which includes two weeks of classroom lessons and six weeks of exercise training. Four hundred physiotherapists have taken the training and, in turn, trained 3,500 patients since January 2013.
Data that were collected and analyzed have shown a decrease in pain and an increase in quality of life for the patients who have completed a GLA:D course. One out of three patients stopped taking medication after three months. One out of three increased their activity level. For example, patients were able to cross a 20 meter roadway two seconds faster after the GLA:D course.
Proactive Care
With these results from just a change in exercise, the potential for COAMI’s impact is immense. To quote from COAMI’s Call to Action: “Paying attention to patients’ symptoms (starting with asking about them in various settings), following up both proactively and longitudinally, and applying the principles of integrated, multi-specialty systems of care all would improve outcomes for the millions of people with OA.”
Ann-Marie Lindstrom is an independent writer and editor based in the Tucson, Ariz., area.
