Background/Purpose: In socialized healthcare systems with free public access to healthcare, there are circumstances wherein patients referred by general medical practitioners (GPs) for specialist physician consultation may not be not offered a first specialist appointment (FSA), when demand exceeds supply. Thus, clinical prioritization is necessary. To address unmet need for FSA in patients with hip or knee osteoarthritis, we initiated and evaluated a physical therapist-led clinic offering non-surgical management of osteoarthritis and outpatient treatment.

Methods: We conducted a program evaluation comprising: a proof-of-concept evaluation, an implementation evaluation, a process evaluation, and an outcomes evaluation. Mixed-methods qualitative and quantitative methodology grounded in health services research were used. Patients, GPs, surgeons, and hospital clinical, management and administrative staff were interviewed and/or surveyed. Patient trajectories were analysed and patient-reported outcome measures were assessed.

Results: The concept model was supported by best-practice literature, and was implemented in close concordance with the model proposed. Qualitative interviews and survey data indicate the “Joint Clinic” has been well accepted by key stakeholders and end-users, is functioning well within the host organisation, is accessible and operating at close to intended capacity. In the 2-year evaluation period, the clinic served 358 new patients [53% female, mean(sd) age 66(10), BMI 29.9(7.5)] in 637 consultations. Unmet need was reduced by 80% compared with pre-implementation for hip/knee OA patients; 30% overall. 31% of patients experienced clinically significant (>20%) improvement on patient-reported outcome measures. 25% of patients were referred for FSA (mean wait 77 days) for fast-track access to joint replacement surgery. 70% of patients were satisfied to be seen by the “Joint Clinic” instead of an orthopaedic surgeon; 98% were satisfied with the knowledge and expertise of the “Joint Clinic” staff; 80% would recommend the clinic to others. Cost-per-patient was NZ$384 (year 2). The host organisation has accepted the service as value-for-money and sustainable.

Conclusion: These data indicate successful implementation and functioning of an innovative service. The service is achieving satisfactory outcomes benefiting patients through clinically significant improvement, monitoring on optimal non-surgical management, or fast-tracked referral for joint replacement surgery.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/program-evaluation-of-the-joint-clinic-an-innovative-clinical-service-for-patients-with-hip-or-knee-osteoarthritis/