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 whole system approach which reaches across the prevention, primary care and secondary care spectrum to support people with lower limb joint problems.
By the end of May 2019 we will provide a personal outcomes approach for 1500 people with lower limb joint problems in Clackmannanshire.
We aim to reduce GP contacts by 1500 and reduce orthopaedic and physiotherapy referrals for lower limb problems by 10%.
- Testing Interventions
The challenge is to reduce barriers to the right care, and increase opportunity for recovery first. We’ve tested a variety of interventions and highlight:
- direct access to a joint pain advisor in primary care, now accessible through 4 GP practices
- hip and knee classes and information / education sessions, with direct access to and from community supports
- extended numbers and reach of exercise classes, with people attending 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
- Results So Far
Our Community Support Model has now supported 586 individuals from Clackmannanshire with lower limb joint problems.
- Joint Advisor New Assistance / Appointments: 488
- Total assistance visits: 601
- Community Based Hip and Knee Exercise class, number of individuals attended: 137
- Around 60% came to the class via self or community (Active Clacks) direction or direct from GP i.e independent of joint advisor.
- Community Hip and Knee Exercise Class, total attendances: 586
- Individuals who have attended Lower Limb Arthritis Education session: 95
- Number of people directed to dietetic support: 17
We are now seeing a positive, evolving and sustained impact on referrals to formal supports within orthopaedics and physiotherapy. We are also seeing a reduction in discharges from first orthopaedic outpatient appointment. We believe that most people discharged at first appointment for orthopaedics could have had their needs met in primary / community services.
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.
“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.”
- Next Steps
Primary care and community and referral onwards process maps have been completed which will add to the patient journey mapping information and help identify cost and value.
We’re starting to measure outcomes post-intervention. So far return rates to primary care are very low and user experience very high.
We hope to have completed and collated user experience from interviews and focus groups which will be used to inform ongoing design.
We have made good use of service designer advice through the ihub, and took part in the Service Design Champions Course, building our own knowledge and skills. We are establishing links with the Scottish Health Council, Forth Valley College, and Glasgow School of Art, all of which will help us:
- expand engagement and identify ways of involving others in capturing user needs
- with service evaluation
- scale up awareness of self-management with general public