Letter to the Editor
Models of healthcare delivery for osteoarthritis
Modelos de prestación de asistencia sanitaria para la artrosis
Francisco Castro-Domíngueza,b,c,
, Luciano Melod,e,f, Jillian P. Eylesd,e,f
Autor para correspondencia
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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Eyles" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Francisco" "apellidos" => "Castro-Domínguez" "email" => array:1 [ 0 => "61362@parcdesalutmar.cat" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luciano" "apellidos" => "Melo" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 2 => array:3 [ "nombre" => "Jillian P." "apellidos" => "Eyles" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Rheumatology Department, Hospital del Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "School of Medicine, Autonomous University of Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cellular Research on Inflammation and Cartilage Unit, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "School of Medicine, University of Sydney, Sydney, New South Wales, Australia" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelos de prestación de asistencia sanitaria para la artrosis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Arriaza R et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> recently concluded that Spain lacks an adequate Model Of Healthcare Delivery System (MoHds) for osteoarthritis (OA). In addition, 68% of the practitioners believe that a prevention program would be necessary to provide adequate care for this disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">OA is a complex disease, and a leading cause of disability worldwide with a substantial societal burden attributed to growing health care costs and loss of productivity.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> At the individual level, OA impacts health-related quality of life.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Even following joint replacement surgery (TJR), there remains a proportion of patients with persistent chronic pain ranging from about 7% to 23% for total hip replacement (THR) and 10% to 34% for total knee replacement (TKR).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In Spain, hip (HOA) and knee osteoarthritis (KOA) have a prevalence of 4% and 10.2% respectively, accounting for about 0.5% of the gross domestic product.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Core treatments for OA (education, access to adequate information, exercise, and weight management) are universally recommended by OA guidelines, but are still not being delivered efficiently by healthcare systems around the world.<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, affecting our own understanding, attitudes and beliefs towards this evidence.<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,<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,<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, at the right time. This thinking is driving the redesign of the MoHds internationally, aiming to provide more effective continuous and patient-centered service models.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The healthcare system should anticipate patient needs and provide appropriate care.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently, new models of comprehensive OA-specific multidisciplinary chronic care programs such as: Better management of patients with osteoarthritis (BOA) in Sweden, Osteoarthritis Chronic Care Program (OACCP) in Australia, Joint Implementation of Osteoarthritis guidelines in the West Midlands (JIGSAW) and Enabling Self-management and Coping with Arthritic Pain using Exercise (ESCAPE) in the UK, Amsterdam osteoarthritis cohort (AMSOA) in Holland and Good life with arthritis in Denmark (GLA:D) have been adopted across the world with encouraging results.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The OACCP, a 52-week multicentre program based on the core interventions of OA guidelines, was implemented in New South Wales in 2012, aiming to reduce TJR surgical waitlists.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Its impact has been shown in the yearly removal rates from TKR (up to 15%) and THR (up to 10%) from joint replacement waitlists due to relevant improvements in pain, function and quality of life.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Another study, states that, 30.6% of the participants who were willing/unsure to have TJR at baseline, were unwilling for surgery by the end of the program.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> A reduction in obesity and hypertension at the end of the program, points to the value of programs like the OACCP as part of the management strategy for patients with a number of chronic disease comorbidities.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Moving forward, a multidisciplinary preventive healthcare approach, supported probably in a creative eHealth technology use, 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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteoarthritis in Spain: a nationwide survey of medical specialists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. 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| 2023 Julio | 44 | 24 | 68 |
| 2023 Junio | 25 | 21 | 46 |
| 2023 Mayo | 33 | 34 | 67 |
| 2023 Abril | 20 | 5 | 25 |
| 2023 Marzo | 56 | 32 | 88 |
| 2023 Febrero | 40 | 30 | 70 |
| 2023 Enero | 30 | 10 | 40 |
| 2022 Diciembre | 48 | 22 | 70 |
| 2022 Noviembre | 42 | 28 | 70 |
| 2022 Octubre | 62 | 30 | 92 |
| 2022 Septiembre | 26 | 40 | 66 |
| 2022 Agosto | 33 | 39 | 72 |
| 2022 Julio | 28 | 33 | 61 |
| 2022 Junio | 40 | 25 | 65 |
| 2022 Mayo | 36 | 33 | 69 |
| 2022 Abril | 77 | 45 | 122 |
| 2022 Marzo | 37 | 39 | 76 |
| 2022 Febrero | 22 | 15 | 37 |
| 2022 Enero | 24 | 34 | 58 |
| 2021 Diciembre | 41 | 41 | 82 |
| 2021 Noviembre | 40 | 40 | 80 |
| 2021 Octubre | 35 | 47 | 82 |
| 2021 Septiembre | 36 | 27 | 63 |
| 2021 Agosto | 20 | 38 | 58 |
| 2021 Julio | 23 | 73 | 96 |
| 2021 Junio | 25 | 25 | 50 |
| 2021 Mayo | 29 | 43 | 72 |
| 2021 Abril | 77 | 71 | 148 |
| 2021 Marzo | 73 | 35 | 108 |
| 2021 Febrero | 38 | 15 | 53 |
| 2021 Enero | 49 | 15 | 64 |
| 2020 Diciembre | 41 | 16 | 57 |
| 2020 Noviembre | 153 | 22 | 175 |
| 2020 Octubre | 126 | 16 | 142 |
| 2020 Septiembre | 70 | 31 | 101 |
| 2020 Agosto | 77 | 26 | 103 |
| 2020 Julio | 45 | 20 | 65 |
| 2020 Junio | 37 | 23 | 60 |
| 2020 Mayo | 51 | 25 | 76 |
| 2020 Marzo | 1 | 0 | 1 |
| 2019 Diciembre | 2 | 2 | 4 |
| 2019 Mayo | 29 | 45 | 74 |
| 2019 Abril | 25 | 17 | 42 |
| 2019 Marzo | 39 | 30 | 69 |
| 2019 Febrero | 23 | 10 | 33 |
| 2019 Enero | 22 | 29 | 51 |
| 2018 Diciembre | 34 | 35 | 69 |
| 2018 Noviembre | 0 | 18 | 18 |
| 2018 Octubre | 0 | 10 | 10 |
| 2018 Septiembre | 0 | 7 | 7 |
| 2018 Agosto | 0 | 9 | 9 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Marzo | 0 | 17 | 17 |
| 2018 Febrero | 0 | 51 | 51 |
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