The project aims to increase our knowledge of the current hand osteoarthritis pathways, the context and mechanisms for shifting tasks between health actors and care levels. We will compare occupational therapist-led care with traditional rheumatologist-led care.
Current health political documents state that patients with osteoarthritis should mainly be managed in primary health care. Still, research shows that patients with hand osteoarthritis have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care.
At the same time, there is according to current guidelines, a shortage of rheumatologists and current guidelines recommend that their time should primarily be allocated to patients with inflammatory rheumatic diseases, for whom early diagnosis, disease-modifying medication and tight controls may induce remission and prevent irreversible joint damage and long-term disability.
This study is a collaborative project between four rheumatology centres across Norway, exploring how tasks may be shifted between actors in healthcare to develop an evidence-based, safe, and cost-effective care pathway for people with hand osteoarthritis.
In WP1 we ask if occupational therapist-led care is as safe, effective and cost-effective as rheumatologist-led care for patients with hand osteoarthritis, in a non-inferiority RCT where 400 participants are included.
In WP2 we interview patients and clinicians involved in hand osteoarthritis care to fully understand current hand osteoarthritis pathways, and the context and mechanisms or logic for shifting tasks between professions and health care levels.
This data material will be complemented with participant observation and text analysis of electronic medical records including referrals and epicrisis from GP-practices treating patients with hand osteoarthritis.
In WP3 we will undertake a modified Delphi consensus exercise to develop a new hand osteoarthritis care pathway and strategies for implementation of the pathway.
The study has been developed in close collaboration with patient research partners, clinicians, and international experts, who will also contribute to the process of integrating study results into clinical practice. The results may also be used to improve access to care for people with other chronic diseases.