Interprofessional Osteoarthritis Care: A Pilot for Interprofessional Care and Education

Main Article Content

Leticia A. Shea Bianca Calderon Joanna Stratton Courtney Duggan Maggie Ehrenfried

Abstract

Background: An osteoarthritis (OA) pilot was initiated in an interprofessional clinic to provide a learning opportunity for practitioners to provide integrated care in the setting of OA to improve health outcomes and quality of life in patients living with osteoarthritis. This study was a qualitative analysis performed following the completion of the pilot.


Purpose: To determine effective processes that support integrated care to best serve those living with osteoarthritis.


Methods: Flyers and neighborhood mailers were provided to the community to inform patients of the OA pilot. Patients were screened by the nurse practitioner and physical therapists to ensure they met osteoarthritis criteria (> 45 years, were experiencing activity-related joint pain, and had no morning joint-related stiffness, or > 30 minutes of morning stiffness). The interventions included one integrated care visit (in-person) followed by telehealth care thereafter. Telehealth visits obtained patient feedback, provided further patient guidance based on patient-response to care plans, and to evaluate change in function, medication usage, and pain management from baseline. The following questions aided researchers to organize our findings following the 3-month pilot: (1) What methods were utilized to aid in patient function and mobility improvement? (2) What was done to ensure safe and effective medication use? (3) How best to utilize each practitioner so that (a) methods for pilot duplication were determined and (b) integrated care best practices were established?


Results: Function and mobility improvement were exhibited in 100% of the patients. Mental health services were utilized to overcome fear of movement and fear of pain barriers to mobility. Half of the patients were originally performing movement exercises that were harmful to their condition prior to obtaining a consult with the physical therapist. The pharmacist-driven medication review during the initial consult identified 88% of the patients were utilizing suboptimal medications for the management of their OA, and 25% were using unsafe dietary supplements. All unsafe medication and dietary-supplement usage was resolved. Establishing care with a team visit supported integrated healthcare engagement. Telehealth and incorporation of healthcare students for follow-up calls were effective for utilization of all practitioners, patient engagement, and supported improved patient outcomes.


Conclusion: The findings of this study outline best practices that support integrated care, integrated education, and improved patient outcomes.

Article Details

How to Cite
SHEA, Leticia A. et al. Interprofessional Osteoarthritis Care: A Pilot for Interprofessional Care and Education. Medical Research Archives, [S.l.], v. 10, n. 9, sep. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2894>. Date accessed: 24 nov. 2024. doi: https://doi.org/10.18103/mra.v10i9.2894.
Section
Research Articles

References

1. Gilbert JHV, Yan J, Hoffman SJ. A WHO report: Framework for action on interprofessional education and collaborative practice. J Allied Health. 2010 Fall;39 Suppl 1;196-7
2. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010 Aug; 26(3):355-369.
3. Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA. Insurer and out-of-pocket costs of osteoarthritis in the US. Arthritis & Rheumatism 2009;60(12):3546-3553.
4. Leifer VP, Katz JN, Losina E. The burden of OA-health services and economics. Osteoarthritis Cartilage. 2022 Jan;30(1):10-16.
5. Hawker GA. Osteoarthritis is a serious disease. Clin Exp Rheumatol. 2019 Sep-Oct;37 Suppl 120(5):3-6.
6. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162.
7. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011
8. Cooper C, Chapurlat R, Al-Daghri N, Herrero-Beaumont G, Bruyère O, Rannou F, Roth R, Uebelhart D, Reginster JY. Safety of Oral Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: What Does the Literature Say? Drugs Aging. 2019 Apr;36(Suppl 1):15-24.
9. Sondergaard KB, Weeke P, Wissenberg M, Olsen AMS, Fosbol EL, Lippert FK, Torp-Pedersen C, Gislason GH, Folke F. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study. European Heart Journal - Cardiovascular Pharmacotherapy, 2016; pvw041
10. Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 Jan;25(1):114-8.
11. Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA - J Am Med Assoc 2013; 310: 1263–1273.
12. Brand CA, Ackerman IN, Tropea J. Chronic disease management: Improving care for people with osteoarthritis. Best Practice & Research Clinical Rheumatology. 2014;28(1):119-142. doi:10.1016/j.berh.2014.01.011
13. Sharma A, Kudesia P, Shi Q, et al. Anxiety and depression in patients with osteoarthritis: Impact and management challenges. Open Access Rheumatol Res Rev 2016; 8: 103–113.
14. Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Phys Rehabil Med. 2016 Jun;59(3):134-138. D
15. National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in Adults. London: National Institute for Health and Care Excellence (UK); 2014 Feb. PMID: 25340227.
16. Oni G, et al. Comparison of five commonly-available, lidocaine-containing topical anesthetics and their effect on serum levels of lidocaine and it metabolite monoethylglycinexylidide (MEGX). Aesthetic Surg Journal. 32(4) 495– 503.
17. Bjelakovic G, Nikolova D, Gluud LL, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842-57.
18. Miller ER 3rd, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: High-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142:60520-53
19. Lonn E, Bosch J, Yusuf S, et al. HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 2005;293:1338-47.
20. Hayden KM, Welsh-Bohmer KA, Wengreen HJ, et al; Cache County Investigators. Risk of mortality with vitamin E supplements: the Cache County study. Am L Med 2007;120:180-4
21. Eichner S, Maguire M, Shea L, Fete M. Banned and discouraged-use ingredients found in weight loss supplements. Journal of the American Pharmacists Association. 2016;56(5):538-543.
22. Shea LA, Leeds M, Bui D, Mujica M. Over-the-counter cannabidiol (CBD) sold in the community pharmacy setting in Colorado. Drugs & Therapy Perspectives 2020;36(12):1-10.
23. Shea LA, Goldwire MA, Hymel D, Bui D. Colorado community pharmacists' survey and their perspectives regarding marijuana. SAGE Open Med. 2020 Jul 29;8:2050312120938215.
24. Mead T, Pilla D. Assessment of clinical and educational interventions that Advanced Pharmacy Practice Experience (APPE) students contributed to a family medicine residency program. Curr Pharm Teach Learn. 2017 May;9(3):460-467.
25. Mersfelder TL, Bouthillier MJ. Value of the student pharmacist to experiential practice sites: a review of the literature. Ann Pharmacother. 2012 Apr;46(4):541-8.
26. Ginzburg R. Impact of pharmacy student interventions in an urban family medicine clinic. Am J Pharm Educ. 2014 Jun 17;78(5):90. doi: 10.5688/ajpe78590. PMID: 24954930; PMCID: PMC4064490.
27. Heuts PHTG, Vlaeyen JWS, Roelofs J, et al. Pain-related fear and daily functioning in patients with osteoarthritis. Pain 2004; 110: 228–235.
28. Trinderup JS, Fisker A, Juhl CB, Petersen T. Fear avoidance beliefs as a predictor for long-term sick leave, disability and pain in patients with chronic low back pain. BMC Musculoskelet Disord. 2018 Dec 3;19(1):431.
29. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317-332.
30. Wang T, He C. Pro-inflammatory cytokines: The link between obesity and osteoarthritis. Cytokine Growth Factor Rev. 2018 Dec;44:38-50.