'Joint Clinic' could be NZ model

An innovative "Joint Clinic" for patients with osteoarthritis, which starts at Dunedin Hospital this week, could become a model for similar clinics elsewhere in the country.

Backed by about $200,000 in funding from the National Health Board, the initiative aims to overcome major unmet needs among patients, and to use limited and costly resources more effectively.

The funding will support the cost of planning and setting up the weekly clinic, and of further research, by Dr Haxby Abbott, to monitor the clinic's effectiveness, during a year-long trial period.

The clinic approach would also address issues involving lengthy waiting times and uncertainty for patients, and aimed to improve overall patient health and fitness and reduce time off work, organisers said.

Dr Abbott is a member of the orthopaedic section of the department of surgical sciences at the University of Otago's Dunedin School of Medicine.

He has helped develop the multi-disciplinary clinic proposal, and prepare a successful application for the national funding.

About 40% of patients with osteoarthritis who are routinely referred to an orthopaedic surgeon by their GPs in Dunedin are currently not seen by a surgeon, after analysis of referral letters, because of limited resources.

And there has previously been no subsequent management advice or follow-up.

Patients not seen by the surgeon could be referred to the multidisciplinary "Joint Clinic", which would address the "unmet need", and would often encourage increased exercise, after careful assessment, Dr Abbott said.

The clinic is affiliated with Dunedin Hospital's orthopaedic outpatient department, and will use an advanced physiotherapy practitioner model to address bottlenecks in the current system.

The Southern District Health Board has employed the equivalent of 2.5 extra full-time staff to run the clinic.

Dr Abbott, who has an Otago PhD in anatomy and is a trained physiotherapist, said as the Otago-Southland population aged, more people were experiencing osteoarthritis. Other trends, such as reduced exercise and increased obesity, contributed to the problems.

He had worked closely with Dr Anne Worsnop, the SDHB GP liaison officer, in developing the clinic proposal, which was jointly backed by the university and the DHB.

The trial component of a major "Management of Osteoarthritis" research programme (2008-2011), funded by the Health Research Council and led by Dr Abbott, had shown significant cost savings through carefully assessing patients and introducing individualised physical exercise programmes and manual therapy.


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