Best practice in pathways and multidisciplinary team working

Osteoarthritis (OA) treatment pathways require effective partnerships between primary and secondary care services and across multidisciplinary teams (MDTs), to ensure that services are available to all patients who need them – and when they need them.

MDT working is essential to effectively deliver care in line with the National Institute for Health and Care Excellence (NICE) management pathway for OA.1

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What services and treatments should be available to patients? Community-based services should use digital tools to provide MDT care ‘closer to home’, in line with the National Health Service (NHS) Five Year Forward View and Long-term Plan.2,3. Referral processes should be clear and timely, aiding General Practitioners (GPs) in their role of being patient advocates and ‘gatekeepers’, while balancing other demands on resources.4 Holistic and patient-centred care is also key, both in initial treatment as well as for the long-term management of patients.5

 

I want to evolve the OA care pathways in my area, what should I consider?

  •  What does your current musculoskeletal (MSK) service look like, and why does it look like this?
  •  Which incremental improvements to OA care pathways could be feasible in your local area (rather than aiming for ‘big changes’)?
  •  Are patients being assessed and treated holistically?

          –  How is the ‘domino effect’ on a patient’s health and life managed?

          –  Are both pharmacological and non-pharmacological treatments considered?

  •  Is there clarity regarding when patients should be referred to specialist care, and who they should be referred to?

          –  Are referrals timely and appropriate?

          –  Are pathways clear – are there redundancies?

  •  Are data and patient outcomes recorded consistently, and is this information used to improve care (what audits are used)?
  •  How is the MDT organised?
  •  Is delivery of OA care in the community at its full potential?
  •  What digital systems and tools could be used to optimise care provision?

           – Is care delivered virtually as much as it could be?

  •  How are surgery waiting times being addressed?
  •  Do patients have a follow-up/monitoring plan in place for their long-term OA care?

          –  Are patients managed with a community-based, ‘closer to home’approach, if appropriate?

What can I do now?

Review your local pathways and management of OA – consider what opportunities for improvement there are, and how you could evolve the practice and pathways.

1. NICE. Pathway: management of osteoarthritis. June 2020. https://pathways.nice.org.uk/pathways/osteoarthritis. Accessed August 4, 2020. 2. NHS. Improvement: Moving healthcare closer to home. September 2015.https://improvement.nhs.uk/resources/moving-healthcare-closer-home/. Accessed August 4, 2020. 3. NHS. The NHS long term plan. January 2019. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf. Accessed February 26, 2020.
4. Musila N, Underwood M, McCaskie AW, Black N, Clarke A, van der Meulen JH. Referral recommendations for osteoarthritis of the knee incorporating patients’ preferences. Fam Pract. 2011;28(1):68-73. 5. NICE. Osteoarthritis: care and management CG177. February 2014. https://www.nice.org.uk/guidance/cg177. Accessed August 4, 2020.

OA treatment pathways require effective partnerships between primary and secondary care services

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Further reading
Osteoarthritis: a leading cause of chronic pain
Osteoarthritis (OA) is a leading cause of chronic pain and disability resulting from structural changes to the joint.1 According to the 2017 Global Burden of Disease study, worldwide an estimated 303 million people live with OA of the hip or knee, and experience…
Key osteoarthritis risk factors, comorbidities and progression
Osteoarthritis (OA)-related pain is caused by structural joint changes and other complex factors that affect how the body processes and experiences pain.1 Persistent pain and functional limitations from OA occur predominantly in the knees and hips of middle-aged and…

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PP-INT-GBR-0216 February 2021