Royal North Shore Hospital (RNSH) / OACCP

In May 2012 the Girgensohn Foundation commenced their support of the Osteoarthritis Chronic Care Program (OACCP). The OACCP, lead by Professor David Hunter, was developed to address the growing burden of osteoarthritis (OA) and its related conditions by providing a coordinated, best practice based, multidisciplinary program for patients who have elected conservative management of their joint disease, or who are waiting to undergo elective lower limb joint replacement surgery. It is estimated that approximately 300 patients with knee or hip OA will participate in the program on an annual basis.

The basis of the program is to provide face to face participant access to clinical staff and health service resources to support self management. The outcomes for persons with knee and hip OA following participation in the OACCP are improved pain, function and quality of life. The program aims to enhance management of co-morbidities, emphasize physical activity and promote healthy weight management (exercise, dietary advice, etc) for their OA.

The initial assessment and subsequent reviews of the participants are completed by the Musculoskeletal (MSK) Coordinator who is a physiotherapist. The MSK coordinator assists each patient to set relevant and achievable goals for the management of their hip or knee OA and provides individualised exercise prescriptions for each patient. Patients may be linked up with community-based health programs, such as falls prevention, hydrotherapy, diabetes education centres, etc, to facilitate self managing their joint disease when required. The major focus of the OACCP is on chronic disease management.

Other expected outcomes include

  • Removal of patients from surgical waiting list due to physical improvement gained through the program
  • Identification of deteriorating patients who require escalation of their surgery date
  • Reduced length of stay and referrals to inpatient rehabilitation for joint replacement patients due to improved physical and psychosocial preparation in the lead up to their surgery
  • Improved relationships between health care professionals associated with OACCP services

In 22 months of operation (March 2012 – Dec 2013) the program accepted 495 new patients. 47.5% were from joint replacement surgery (JRS) waiting lists, 31.5% directly referred from Orthopeadic Surgeons, 14% from Rheumatologists, and 7% from other sources including GPs.

Of the 253 participants recruited to the OACCP whilst waiting for elective JRS, 41 (16%) have been officially removed from JRS waiting lists as a direct result of improvements made from the program. This is consistent with the expectation that approximately 15% OACCP participants will be removed from the JRS waiting list in a rolling calendar year. 18 patients have successfully be escalated to surgery at the request of the OACCP team.

It is very encouraging that OACCP participants have shown significant clinical improvements whilst on the program. The OACCP provides valuable health benefits for participants with hip and knee OA, and ‘prehabilitation’ for participants who require JRS at RNS and Ryde Hospitals.

After 2 years of operating as a pilot project, in late 2013, the OACCP was awarded recurrent funding from the RNSH executive to become a permanently operating outpatient service.