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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Arriaza R et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> recently concluded that Spain lacks an adequate Model Of Healthcare Delivery System &#40;MoHds&#41; for osteoarthritis &#40;OA&#41;&#46; In addition&#44; 68&#37; of the practitioners believe that a prevention program would be necessary to provide adequate care for this disease&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">OA is a complex disease&#44; and a leading cause of disability worldwide with a substantial societal burden attributed to growing health care costs and loss of productivity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> At the individual level&#44; OA impacts health-related quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Even following joint replacement surgery &#40;TJR&#41;&#44; there remains a proportion of patients with persistent chronic pain ranging from about 7&#37; to 23&#37; for total hip replacement &#40;THR&#41; and 10&#37; to 34&#37; for total knee replacement &#40;TKR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In Spain&#44; hip &#40;HOA&#41; and knee osteoarthritis &#40;KOA&#41; have a prevalence of 4&#37; and 10&#46;2&#37; respectively&#44; accounting for about 0&#46;5&#37; of the gross domestic product&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Core treatments for OA &#40;education&#44; access to adequate information&#44; exercise&#44; and weight management&#41; are universally recommended by OA guidelines&#44; but are still not being delivered efficiently by healthcare systems around the world&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> This could be due to the existence of a knowledge translation gap in the implementation of evidence in the field of OA&#44; affecting our own understanding&#44; attitudes and beliefs towards this evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">With OA self-management programs demonstrating only small treatment effects for people with KOA&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and the forecast of a dramatic increase in rates of TKR surgeries towards 2030&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> more effort should be given to the implementation of programs that deliver the right OA treatment to the right person&#44; at the right time&#46; This thinking is driving the redesign of the MoHds internationally&#44; aiming to provide more effective continuous and patient-centered service models&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The healthcare system should anticipate patient needs and provide appropriate care&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently&#44; new models of comprehensive OA-specific multidisciplinary chronic care programs such as&#58; Better management of patients with osteoarthritis &#40;BOA&#41; in Sweden&#44; Osteoarthritis Chronic Care Program &#40;OACCP&#41; in Australia&#44; Joint Implementation of Osteoarthritis guidelines in the West Midlands &#40;JIGSAW&#41; and Enabling Self-management and Coping with Arthritic Pain using Exercise &#40;ESCAPE&#41; in the UK&#44; Amsterdam osteoarthritis cohort &#40;AMSOA&#41; in Holland and Good life with arthritis in Denmark &#40;GLA&#58;D&#41; have been adopted across the world with encouraging results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The OACCP&#44; a 52-week multicentre program based on the core interventions of OA guidelines&#44; was implemented in New South Wales in 2012&#44; aiming to reduce TJR surgical waitlists&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Its impact has been shown in the yearly removal rates from TKR &#40;up to 15&#37;&#41; and THR &#40;up to 10&#37;&#41; from joint replacement waitlists due to relevant improvements in pain&#44; function and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Another study&#44; states that&#44; 30&#46;6&#37; of the participants who were willing&#47;unsure to have TJR at baseline&#44; were unwilling for surgery by the end of the program&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> A reduction in obesity and hypertension at the end of the program&#44; points to the value of programs like the OACCP as part of the management strategy for patients with a number of chronic disease comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Moving forward&#44; a multidisciplinary preventive healthcare approach&#44; supported probably in a creative eHealth technology use&#44; have the potential to enhance the delivery of cost-effective holistic interventions and help to compile large-scale data registries that could lead to improve the chronic healthcare management and optimize the research goals&#46;</p></span>"
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Letter to the Editor
Models of healthcare delivery for osteoarthritis
Modelos de prestación de asistencia sanitaria para la artrosis
Francisco Castro-Domíngueza,b,c,
Corresponding author
61362@parcdesalutmar.cat

Corresponding author.
, Luciano Melod,e,f, Jillian P. Eylesd,e,f
a Rheumatology Department, Hospital del Mar, Barcelona, Spain
b School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
c Cellular Research on Inflammation and Cartilage Unit, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
d Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
e School of Medicine, University of Sydney, Sydney, New South Wales, Australia
f Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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there remains a proportion of patients with persistent chronic pain ranging from about 7&#37; to 23&#37; for total hip replacement &#40;THR&#41; and 10&#37; to 34&#37; for total knee replacement &#40;TKR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In Spain&#44; hip &#40;HOA&#41; and knee osteoarthritis &#40;KOA&#41; have a prevalence of 4&#37; and 10&#46;2&#37; respectively&#44; accounting for about 0&#46;5&#37; of the gross domestic product&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Core treatments for OA &#40;education&#44; access to adequate information&#44; exercise&#44; and weight management&#41; are universally recommended by OA guidelines&#44; but are still not being delivered efficiently by healthcare systems around the world&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> This could be due to the existence of a knowledge translation gap in the implementation of evidence in the field of OA&#44; affecting our own understanding&#44; attitudes and beliefs towards this evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">With OA self-management programs demonstrating only small treatment effects for people with KOA&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and the forecast of a dramatic increase in rates of TKR surgeries towards 2030&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> more effort should be given to the implementation of programs that deliver the right OA treatment to the right person&#44; at the right time&#46; This thinking is driving the redesign of the MoHds internationally&#44; aiming to provide more effective continuous and patient-centered service models&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The healthcare system should anticipate patient needs and provide appropriate care&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently&#44; new models of comprehensive OA-specific multidisciplinary chronic care programs such as&#58; Better management of patients with osteoarthritis &#40;BOA&#41; in Sweden&#44; Osteoarthritis Chronic Care Program &#40;OACCP&#41; in Australia&#44; Joint Implementation of Osteoarthritis guidelines in the West Midlands &#40;JIGSAW&#41; and Enabling Self-management and Coping with Arthritic Pain using Exercise &#40;ESCAPE&#41; in the UK&#44; Amsterdam osteoarthritis cohort &#40;AMSOA&#41; in Holland and Good life with arthritis in Denmark &#40;GLA&#58;D&#41; have been adopted across the world with encouraging results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The OACCP&#44; a 52-week multicentre program based on the core interventions of OA guidelines&#44; was implemented in New South Wales in 2012&#44; aiming to reduce TJR surgical waitlists&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Its impact has been shown in the yearly removal rates from TKR &#40;up to 15&#37;&#41; and THR &#40;up to 10&#37;&#41; from joint replacement waitlists due to relevant improvements in pain&#44; function and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Another study&#44; states that&#44; 30&#46;6&#37; of the participants who were willing&#47;unsure to have TJR at baseline&#44; were unwilling for surgery by the end of the program&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> A reduction in obesity and hypertension at the end of the program&#44; points to the value of programs like the OACCP as part of the management strategy for patients with a number of chronic disease comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Moving forward&#44; a multidisciplinary preventive healthcare approach&#44; supported probably in a creative eHealth technology use&#44; have the potential to enhance the delivery of cost-effective holistic interventions and help to compile large-scale data registries that could lead to improve the chronic healthcare management and optimize the research goals&#46;</p></span>"
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