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Back pain is one of the most common reasons for visits to the family physician.
Clinician-scientists developing new approach to treating joint pain
Back, knee and shoulder pain are among the most common reasons for a visit to the doctor’s office. In addition to pain, loss of sleep, reduced productivity and depression often result from a frustrating waiting game, when it may take months, even years to get an effective care plan, especially for patients suffering from arthritis.
“There’s nothing more frustrating for these patients than to wait months to see a spinal surgeon, only to be told that surgery is not the answer,” says Arthritis Program Spinal Surgeon Dr. Raja Rampersaud.
(Inter-professional Spine Assessment and Education Clinics). ISAEC is a model of care in which patients receive rapid low back pain assessment (less than two weeks on average), education and evidence-based management plans. It is designed to decrease the prevalence of unmanageable chronic low back pain, reduce unnecessary diagnostic imaging as well as unnecessary specialist referral. Patients are assessed by a chiropractor or physiotherapist who has been trained as an ISAEC Advanced Practice Clinician. A physician spine specialist provides ongoing clinical support and oversight of the advanced practitioners. ISAEC clinicians are located in the three program cities: Hamilton, Thunder Bay and Toronto.
In a separate project, patients can use an “arthritis care” app that asks 5 to ten easy questions that help their healthcare provider personalize their care.
Using a point-of-care algorithm, the tool helps the family physician identify which patients would benefit from exercise and lifestyle interventions such as physical therapy and weight loss, or those patients who should be referred to an orthopaedic surgeon.
Using the “SMART” goals approach: specific, measurable, attainable, realistic and timely; the module is designed to provide the patients with reminders and cues to support their treatment plans.
“Instead of waiting in pain and anxiety for months to see a specialist, patients can be starting their own treatment plans with information and tools that they need,” explains Dr. Rampersaud. “It increases their confidence to manage their own condition.”
“It also enables more effective interaction with their healthcare providers,” he adds.
Changing the health system
From a health economics perspective, the ISAEC model has shown that there is a 33 per cent reduction in unnecessary MRI procedures.
“We have shown this with 200 doctors. Imagine what the savings would be if this were rolled out to Ontario’s 8,000 family physicians.”
UHN is a proven leader in bringing new innovations and practice models to the healthcare system. The Arthritis Program is a prime example. Building on the initial success of the ISAEC study, specialists in the Arthritis Program will help expand this approach to knee and shoulder pain.
“We are eliminating the shotgun approach to treating joint pain,” says Dr. Rampersaud. He and Orthopaedic Surgeon Dr. Christian Veillette are co-directing the Arthritis Health System Innovation Change Lab. Dr. Veillette is leading the development of information technology to capture patient data. His aim is to harness the data they have collected to track patient behaviour. Ultimately, healthcare professionals will be able to monitor patients to see if they are complying with their regimens, and if not, work with these patients to change the care plan.
For patients who do require surgery to treat their conditions, Dr. Rampersaud believes this new approach will reduce their waiting times.”
To support the work of Drs. Rampersaud and Veillette and their colleagues in the Orthopaedic Surgery Program, please contact Anette Larsson at firstname.lastname@example.org or 416 603 5800 x4059.
Donors Fund Major Research Initiative to Develop New Models of Care
With over 4.5 million Canadians affected by the disease, arthritis is one of Canada’s most costly chronic conditions. Effective treatments can be elusive, leaving both physicians and their patients grasping for answers.
Now donors are stepping up to advance research in this area. For example, former TD Canada Trust CEO Ed Clark has made a $2 million donation to help launch a pioneering new enterprise: the Arthritis Health System Innovation Change Lab. Dedicated to developing new models of arthritis care, the lab is building on the collaborative nature of UHN’s Arthritis Program. Project goals include developing a multidisciplinary team that includes front-line healthcare providers, innovators in health services and informatics, as well as administrative, business and policy leaders.
Co-directors Dr. Christian Veillette and Dr. Raja Rampersaud will oversee the creation of this focused initiative, utilizing information accrued from a variety of research endeavours to evaluate and implement effective system changes.
Including staffing requirements and infrastructure support, total funding of $10 million has been identified to complete the lab. “Thanks to Ed Clark’s support, we are well on the way to building an indispensable resource,” enthuses Dr. Rampersaud, “making fundamental improvements that dramatically improve arthritis research, education and patient care.”