B&J HEALTH TOPICS - PROBLEMS

Degenerative Joint Disease

Degenerative joint disease affects over 10 per cent of the Alberta population, and osteoarthritis and rheumatoid arthritis represent the most common causes of the disease.  There is evidence of osteoarthritis in 70 per cent of people over the age of 70, and arthritis is the second most common cause for a visit to the doctor.

Degenerative joint disease most commonly occurs in the hips and knees and causes substantial pain and functional impairment because these are the largest weight-bearing joints in the body. 

Osteoarthritis is the leading cause of degenerative joint disease and can have physical, psychological and economic consequences for those affected.  Osteoarthritis is characterized by the degeneration of the joint cartilage and adjacent bone, leading to chronic pain and stiffness.  As a consequence, patients with severe degenerative joint disease typically have considerably lower quality of life.  Generally, as quality of life diminishes, the consumption of health resources increases.

Joint Replacements

Over the past 40 years, total joint replacement has been recognized as one of the most effective surgical interventions for joint deterioration.  It is an effective way to relieve pain, improve mobility and increase function in the joint. 

Total joint replacement has the potential to transform a patient’s quality of life by reducing chronic pain and increasing the ability to function independently.

In 2000-2001, Alberta was identified as having the highest rate of total joint replacement in Canada, and the rate is expected to continue rising.  During the period from 2001 to 2004, the number of people waiting for a hip or knee replacement increased by about 72 per cent, despite an increase in targeted funding for total joint replacement surgery. 

While demand for hip and knee replacements is increasing, the rate of surgery is insufficient to meet current and future needs.  This is reflected in the long waiting times for these procedures.

Improving Access to Care

Several initiatives were undertaken to reduce the wait times for hip and knee replacement surgery.

1. In 2002, Alberta Health and Wellness established the Access Standards Working Group in response to the report by the Premier’s Advisory Council on Health, which recommended a guarantee of access to selected health services.  Orthopaedic services were one of those identified by the working group.  The working group established principles that included:
1. Access standards in one area of care should not have a negative impact on other health services.
2. Patient urgency should be identified.
3. Health delivery and outcomes should be optimized.
4. Best clinical evidence should be incorporated.
5. Patients and providers should be given choice (even though this may affect access time).
6. The system should be flexible.

2. The Alberta Bone and Joint Health Institute, together with the provincial government, the Alberta Medical Association, and the Calgary, Capital and David Thompson health regions, explored how services could be delivered to improve access to hip and knee replacement surgery within a targeted timeframe based on urgency. 

A shared care model evolved in which primary care physicians are more involved in preparing patients for surgery and caring for them after surgery.  Patients are assessed at a central clinic using standardized criteria to determine suitability for surgery.  This should reduce the number of inappropriately referred patients, particularly those who do not require surgery. 

Patient urgency is rated using the Western Canada Waiting List project’s rating tools – the first practical evaluation of these tools in Canada.  By centralizing the booking function, patients can be referred to the most appropriate surgeon with the shortest wait list.

3. To confirm that the new model will improve care and reduce wait times, the provincial government funded a pilot project.

The Alberta Hip and Knee Replacement Pilot Project

The ABJHI’s new bone and joint health care model was tested in a pilot project to perform 1,200 hip and knee replacements, beginning in May 2005.  The pilot involved:

• Three health regions – Capital, David Thompson and Calgary.
• 13 orthopaedic surgeons.
• Three assessment intake clinics – Health First Strathcona in Edmonton, Health Resource Centre in Calgary, and Central Alberta Hip and Knee Clinic in Red Deer.
• One location for surgery in each city, with staff dedicated to the pilot – Royal Alexandra Hospital in Edmonton, Health Resource Centre in Calgary, and Red Deer Regional Hospital.
• All patients following the same care pathway, regardless of location.

Interim results of the pilot, based on almost 500 surgeries performed over a five-month period from May to September 2005 showed:

• Significant improvement in patient and health care provider satisfaction
• Faster recovery and enhanced patient engagement and education

• Increased efficiency with major gains in the number of surgeries per day per operating room
• No increases in costs per case from time of referral to discharge from hospital—the same dollars provided faster, more satisfying care

The final report on the results of the pilot is expected to be released in fall 2006.

Other Common Disorders

Osteoporosis

Degenerative Joint Disease