scholarly journals A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme

2020 ◽  
Vol 8 ◽  
pp. 205031212094652
Author(s):  
Thomas W Wainwright ◽  
Louise C Burgess ◽  
Tikki Immins ◽  
Neil Cowan ◽  
Robert G Middleton
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Secondary Care ◽  
Weight Bearing ◽  
Hip Osteoarthritis ◽  
Hip Pain ◽  
Education Intervention ◽  
Timed Up And Go ◽  
Original Cohort ◽  
Patient Reported

Objectives: The Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme. Methods: The replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks. Results: The participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise. Conclusion: A 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.

scholarly journals Self-Management of Hip Osteoarthritis Five Years After a Cycling and Education Treatment Pathway

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 37
Author(s):  
Thomas W. Wainwright ◽  
Louise C. Burgess ◽  
Tikki Immins ◽  
Robert G. Middleton
Keyword(s):  
Hip Osteoarthritis ◽  
Education Programme ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hip Pain ◽  
Long Term Effects ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Pathway ◽  
Patient Reported

The Cycling against Hip Pain (CHAIN) programme is a six-week cycling and education treatment pathway for people with hip osteoarthritis. Preliminary results demonstrated significant improvements in clinical and patient-reported outcome measures following the course. Whilst the benefits of exercise for osteoarthritis are often reported in the short term, less is known about the long-term effects for this patient group. This study explores whether participants continued to self-manage their hip osteoarthritis five years after completing the course. A cross-sectional survey was conducted to collect data from participants who completed the CHAIN programme between October 2013 and February 2015 (n = 96). Questionnaires were sent by post in April 2019, and then non-responders were followed up again four weeks later. Eighty-three (87%) participants responded to the survey. Five years (range 4–6) after completion of a six-week cycling and education programme, 37 (45%) participants had not returned to their general practitioner for further treatment of their hip pain, and 47 (57%) had not pursued surgical intervention. All participants were still engaged in at least one physical activity per week and many reported that they had purchased a bike (29%), joined a gym (30%) or cycled regularly (indoor cycling 25%, outdoor cycling 24%). Eighty (96%) participants reported an increase in knowledge of self-managing their symptoms. The findings from this study suggest that many patients are motivated to self-manage their hip osteoarthritis, five years following a six-week cycling and education treatment pathway that encourages lifestyle change.

Medicines reconciliation of biologics on a primary care clinical system

2021 ◽  
Vol 3 (7) ◽  
pp. 274-280
Author(s):  
Sam Appiah-Anane
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Secondary Care ◽  
Care Setting ◽  
Quality Improvement Project ◽  
Care Providers ◽  
Snomed Ct ◽  
Improvement Project ◽  
Medicines Reconciliation ◽  
Clinical Systems

With increasing number of biologics gaining approval from the National Institute for Health and Care Excellence for a wide variety of both cancer and non-cancer clinical indications in secondary care, the need for accurate medicines reconciliation in primary care also increases. The risk of patient harm from incomplete medicines reconciliation is a consideration, particularly when patient data is transferred from a secondary care setting to a primary care setting. As part of a prescribing quality improvement project, a list of biologics prescribed by secondary care providers were reconciled on to patients' primary care clinical systems (EMIS) by clinical pharmacists and pharmacy technicians at a Clinical Commissioning Groups. Patients were identified by cross-referencing high cost drug reports with clinical diagnostic codes (a mixture of READ codes and SNOMED-CT terms) on primary care clinical systems. In total, 192 medicines were reconciled safely on the relevant patients' notes across 16 different GP practices A further 81 medicines had already been reconciled at the start of the quality improvement project. The purpose of this article is three-fold; to expand the awareness of biologics in the context of medicines optimisation in the primary care arena, to discuss medicines reconciliations of biologics in primary care, including the role(s) of pharmacy professionals, and to discuss the wider implications of prescribing biologics in the light of ethical considerations such as veganism.

scholarly journals Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046712
Author(s):  
Rory Ferguson ◽  
Daniel Prieto-Alhambra ◽  
George Peat ◽  
Antonella Delmestri ◽  
Kelvin P Jordan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Status ◽  
Elderly People ◽  
Secondary Care ◽  
Frailty Index ◽  
Hip Osteoarthritis ◽  
High Morbidity ◽  
Total Hip

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.ObjectiveTo evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.SettingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.ParticipantsA total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA.Outcome measures(1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.ResultsPerioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.ConclusionsIndependent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.

scholarly journals Influence of pre-existing multimorbidity on receiving a hip arthroplasty: cohort study of 28 025 elderly subjects from UK primary care

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046713
Author(s):  
Rory Ferguson ◽  
Daniel Prieto-Alhambra ◽  
George Peat ◽  
Antonella Delmestri ◽  
Kelvin P Jordan ◽  
...  
Keyword(s):  
Primary Care ◽  
Hip Arthroplasty ◽  
Secondary Care ◽  
Frailty Index ◽  
Hip Osteoarthritis ◽  
The Elderly ◽  
Practice Research ◽  
Elderly Subjects ◽  
Clinical Practice Research Datalink ◽  
The Impact

The median age for total hip arthroplasty (THA) is over 70 years with the corollary that many individuals have multiple multimorbidities. Despite the predicted improvement in quality of life, THA might be denied even to those with low levels of multimorbidity.ObjectiveTo evaluate how pre-existing levels of multimorbidity influence the likelihood and timing of THA.SettingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.ParticipantsA total of 28 025 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register, Clinical Practice Research Datalink. Data were extracted from the database on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index and counts of chronic diseases (from list of 17), prescribed medications and number of primary care visits prior to recording of osteoarthritis.Outcome measuresThe record of having received a THA as recorded in the primary care record and the linked secondary care database: Hospital Episode Statistics.Results40% had THA: median follow 10 months (range 1–17 years). Increased multimorbidity was associated with a decreased likelihood of undergoing THA, irrespective of the method of assessing multimorbidity although the impact varied by approach.ConclusionMarkers of pre-existing ill health influence the decision for THA in the elderly with end-stage hip osteoarthritis, although these effects are modest for indices of multimorbidity other than eFI. There is evidence of this influence being present even in people with moderate decrements in their health, despite the balance of benefits to risk in these individuals being positive.

Abstract 223: Innovations in Quality Improvement

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Nicole Ansani-Jankowski ◽  
Robert Madder
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Diabetes Care ◽  
Primary Care Physicians ◽  
Screening Tools ◽  
Secondary Outcome ◽  
Diabetic Patients ◽  
Office Visits ◽  
Time Period ◽  
Patient Reported

Innovative Medical Platform Optimizing Research and Technology (IMPORT)> Background: A medical group, pharmaceutical company, and data harvesting and integration company collaborated to test an innovative approach to quality improvement (QI) that utilizes clinical expertise, advanced outcomes analytics, electronic medical records (EMR), and a cloud technology data harvesting platform. The objective of this project was to measure the ability of this collaborative project to effectively and efficiently identify quality improvement opportunities. Methods: This was a retrospective EMR analysis which utilized Solution for Quality Improvement (SQI) platform on an advanced electronic medical record system. All patients in one primary care medical practice seen from 7/1/2009 - 7/31/2011 were included. The primary outcomes were effectiveness of the platform to integrate data, measured by data density of diabetes laboratory and clinical quality performance values from structured EMR fields and unstructured physician notes; and efficiency, measured as the time period from SQI data mapping to final results analysis. A secondary outcome was the ability of the project to identify and target meaningful QI opportunities. Results: SQI collected data from 9,294 patient records, including 73,706 office visits and 35,602 physician dictated visit notes. Of these records, 6,251 cardiovascular patients were identified with diabetic patients accounting for 1,561 (25%) of these. Values and measurement dates for A1c, LDL, and blood pressure values were harvested in 83%, 75%, and 96% of these diabetic patients, respectively. The collection of other diabetic preventive services performance indicators was relatively low. Additional QI is being done to ensure complete capture of data. The time period for analysis, including 3 iterative rounds of expanded data identification, was 15 weeks total. Through this project, 3 specific areas of QI were prioritized: improve dictation/documentation of preventative diabetes care recommendations; implement diabetes panel management; and develop electronic diabetes patient reported outcomes screening tools. Conclusion: This collaboration led to an efficient and effective QI analysis in diabetes care. Results of the analysis have led to development and implementation of meaningful QI initiatives. Future implications include the use of this project’s approach to rapidly re-measure performance after implementation of the QI initiatives and expansion of the collaboration from a 4 physician practice to the network of 100 primary care physicians.

scholarly journals Adult hip pain

2019 ◽  
Vol 13 (1) ◽  
pp. 21-27
Author(s):  
Aman Jain ◽  
Katie Clamp
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Secondary Care ◽  
Management Strategies ◽  
Hip Pain ◽  
Good Knowledge ◽  
Musculoskeletal Conditions ◽  
Urgent Referral ◽  
Common Causes ◽  
Anatomy Of The Hip

Hip pain is one of the most common musculoskeletal presentations in general practice. There are multiples causes of hip pain, ranging from acute to chronic and traumatic to atraumatic. In general practice, it is important to identify the cause of hip pain, as management strategies vary depending on pathology. Some diagnoses need urgent referral to secondary care, whereas others can be managed in primary care. According to the RCGP, an estimated 1-in-5 consultations are for musculoskeletal conditions, so a good knowledge of management is important. In this article, we will discuss the anatomy of the hip, the most common causes of hip pain and their management.

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