Bristol Bones and Joints

1. Bristol Bones and Joints 12 June 2015

2. Integrate across the city: clinical service delivery, research & innovation, education & training Inflammatory arthritis Osteoarthritis Osteoporosis Collaboration with patients Informatics Self-Management support

3. Bristol Bones and Joints: Aims Patients Primary Care Clinical Commissioners Bristol City Council

4. Bristol Bones and Joints: Who’s involved? • Co-directors: • Sarah Hewlett Professor Rheumatology Nursing, UWE • Hon Consultant Nurse, UHB • Ashley Blom Professor of Orthopaedics, UoB • Consultant Orthopaedic Surgeon, NBT • Emma Clark Cons Senior Lecturer Rheumatology, NBT & UoB • (Mike Whitehouse, CSL Orthopaedics, NBT & UoB)

5. Bristol Bones and Joints: Overarching aims Osteoarthritis and Arthroplasty Pathways: Primary care pathways and Surgical care pathways Inflammatory Arthritis Pathway: Stepped Care: From intensive control to FU /Direct Access Osteoporosis Fragility Fracture Pathways: Primary fracture and secondary fracture prevention pathways Collaboration with patients: Help us understand what is important and prioritize Informatics: Web-based single point of information (patients/professionals) Self-management support: Access to evidence-based support (whole teams/programmes)

6. Bristol Bones and Joints: Osteoarthritis • National Joint Registry now held here • Getting It Right First Time – analysis undertaken at NBT • Cemented hip replacements now agreed • Increased from 40% to 92% • Saving £170,000/year at NBT via 1000 THRs • AHSN roll out anticipated

7. Bristol Bones and Joints: Inflammatory Arthritis • RA Drug monitoring: standardized for GPs across Trusts • Evidence-based, regular updates planned • Reduce confusion for GPs with patients in both Trusts • Improve safety, reduce anxiety • RA patient pathway from diagnosis (evidence-based) • UHBristol Best Practice award from BSR • NBT utilized information for similar pathway

8. Bristol Bones and Joints: Osteoporosis & Fragility Fractures • Regular combined pan-Bristol meetings • Meeting on Osteonecrosis of Jaw with dentists • Patient-based quality indicators developed for the pan-Bristol DXA scanning service • Working on incorporating vertebral fractures into the Fracture Liaison Service across Bristol

9. Bristol Bones and Joints: Patient collaboration Executive Patient Partners (OA, IA, OP) • Help us understand patient needs • Understand our current provision • Help interpret and apply evidence • Help identify knowledge gap Wider patient groups/public • Consultation and prioritization on what to take forward

10. Bristol Bones and Joints: Patient collaboration • 2013 Pathways meeting • Collaboration: • PPI in each pathway • Hard to reach groups included • Evaluate pathway by patient Qs • Training: • Improve collaboration in consultation • Training for staff • Make patient involvement ‘normal’ • Patient involvement in RA pathways • Review of collaborative consultations

11. Bristol Bones and Joints: Collaboration with patients • 2014: Working together Meeting • Self-Management: • Holistic, collaborative care • Include psychological wellbeing • Train staff and patients in the skills needed • Grant application for 5 year programme • Fellowship for needs of men • Osteoporosis: • Patients need their DXA results • Screening is vital • Grant applications for programme of work •  Patients receive DXA summary

12. Informatics Two STRs awarded time to work on this project Website to be hosted/supported by NBT Access point for MSK care across city For patients and professionals Wide range of resources and links Draft website to be piloted at the patient meeting 22 June

13. Self-Management Meeting across Trusts Where possible ensure existing programmes evidence-based Avoid didactic information giving Research Fatigue self-management Men’s needs Psychological support OA self-management Access to any MSK self-management programme across the Trusts is the eventual aim

14. Forthcoming work AHSN roll out of cemented THR Surgical infection – RCT Direct Access for Psoriatic Arthritis Patients New lead (new posts) Improving medication adherence Develop vertebral fractures pathway

15. Forthcoming work PPI Meeting 22 June Websites, self-management, research Pilotting of website 22 June Scoping exercise UHB/NBT PhD studentship: activation 1-1 Fatigue; Men’s needs

16. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-knee) • 6/52 Exercise and SMI • Social Cognitive Theory • Enhanced Self-efficacy • Delivered in Primary Care • Physio-led • RCT (n=420) • Compared to GP care Cost savings: Approx £260/patient compared to ‘standard’ physiotherapy (over 12 months) Approx £1100/patient compared to GP care (over 30 months)

17. Crystal Palace Physiotherapy & Sports Injury Centre Pulross Centre, Brixton (GSTT) Queen Mary’s Hospital, Sidcup (ONFT) Croydon University Hospital (CHSNT) Wimbledon Clinics, Parkside Hospital, Wimbledon Queen Elizabeth Hospital, Woolwich Dulwich Community Hospital (KCHNFT) St George’s Hospital (SGHNFT) Kings College Hospital (KCHNFT) Lewisham Hospital (LGHNT) ESCAPE Implemented in South London (AHSN)

18. The Long and Winding Road… …takes a decade to travel!! Website launch Commissioned S London 2014 Clinical Feasibility 2009 LT Papers 2012 NICE (2014) Guidelines Initial Funding 2000 QIPP Approval 2013 Hip Feasibility 2010 Papers 2007 RCT 2001-2005 NICE (2008) Guidelines (Stelvio Pass, Italy)

19. Questions? Theme leads: Osteoarthritis: Ashley Blom Ashley.Blom@nbt.ac.uk Inflamm Arthritis: (Sarah Hewlett) Sarah.Hewlett@uwe.ac.uk Osteoporosis: Emma Clark Emma.Clark@Bristol.ac.uk Patient collab: John Kirwan John.Kirwan@Bristol.ac.uk Informatics: Emma Clark Emma.Clark@Bristol.ac.uk Self-manage: Sarah Hewlett Sarah.Hewlett@uwe.ac.uk