Best In Class Approach To Managing Lower Limb Joint Problems
Clackmannanshire and Stirling HSCP
People with knee problems routinely look for healthcare information and services through their GP. However, most degenerative joint problems do not need a GP to diagnose and direct treatment. People can be empowered to better manage their own recovery.
This project is part of a Best in Class (BIC) whole system approach which reaches across the prevention, primary care and secondary care spectrum to support people with lower limb joint problems.
The aim of this work was to provide a personal outcomes approach for up to 1500 people with lower limb joint problems in Clackmannanshire.
Additional aims were to:
- reduce GP contacts by 1500 and
- reduce orthopaedic referrals for hip and knee problems by 10%, and
- reduce physiotherapy referrals for lower limb problems by 10%
The project was supported by grant funding from the ihub's Improvement Fund in 2017-2018.
- What was the approach?
The approach was to look at the impact of a number of interventions on reducing barriers to the right care and the increased opportunity for recovery first. Interventions included:
- direct access to a joint pain advisor in primary care, accessible through 5/7 GP practices
- providing interventions such as injection therapy for specific patients in primary care, rather than referring to secondary care services
- hip and knee classes and information / education sessions, with direct access to and from community supports
- the creation and extended reach of hip and knee exercise classes
- partner, with people encouraged to attend classes as first point of support
- the importance of having good conversations about weight and its impact, and signposting to local and online resources to help with weight management
- introducing specialist dietetic support, with referrals for people who would like further support through
- weight management sessions, and
- roll all of the above principles out across Forth Valley at the end of the initial project period.
This approach made good use of service designer advice through the ihub, and the team took part in the Service Design Champions course to build knowledge and skills regarding service design. The aim of this was to support the long term aims of the project by:
- expanding engagement and identifying ways of involving others in capturing user needs
- supporting service evaluation, and
- exploring methods for scaling up awareness of self-management with general public.
- What was the impact?
Outcome measures were completed at first Joint Pain Advisor appointment and sought follow up outcomes around 3 months post appointment. 133 of the 544 individuals completed both pre and post outcome measure- 25% completion rate.
Of those 133,
- 65% were improved by a statistically significant margin
- 17% were improved but not by a statistically significant margin
- 10% had no change in score and 8% were worse.
More people are able to access and benefit from the joint pain service. People are accessing exercise, dietetics and other services. There has been a 36% reduction in the median weekly referral number to orthopaedics.
Those attending classes, sessions and dietetic support have described the benefits of the project, helping people understand what’s happening with their joints and to feel empowered to improve themselves.
One participant said:
“Coupled with your exercise regime and pilot study, attending the local Hip and Knee Exercise sessions improved my recovery immensely following surgery, the hospital physio was impressed but advised it was through completing the pre-op exercises - on two walking sticks the day after surgery. Regardless of pending surgery or not - exercise does help immensely - it doesn't have to be painful.”
- What are the next steps?
At the conclusion of the project plans were established to share learning and further develop practice:
- roll out the approach across Forth Valley
- expansion of those delivering BIC principles
- expand community classes
- expand information sessions, and
- strengthen links between primary care, secondary care and community services.