KNEE OSTEOARTHRITIS (OA) EDUCATION SESSION: A COMMUNITY HOSPITAL'S EFFORT TO IMPROVE ACCESS TO CARE FOR PATIENTS REFERRED TO THE HIP AND KNEE RAPID ACCESS CLINIC

Since 2010, the region adopted the Rapid Access Clinic model for referrals from primary care for patients being considered for hip or knee replacement. This process involves an initial assessment by a nurse or specially trained physiotherapist. The visit includes an intake of medical history, joint history, physical examination and x-ray review. This is followed by a comprehensive discussion with the patient regarding their options. Patients who are potential surgical candidates and interested in pursuing this option are referred to a surgeon. Overall, approximately 40% of patients are not surgical candidates or yet ready to proceed to a surgical consult. Many patients referred to the program have not yet optimized non-surgical treatment. Since the pandemic, the wait time for initial assessment at RACs across the region increased from approximately 2 to 3 months to 6 to 8 months. To address this backlog, a pilot project at a leading local hospital's RAC site was proposed to target patients referred with mild to moderate OA as they are most likely to be streamed to optimize non-surgical treatment measures. A class format was developed, providing evidence-based education regarding pathology and conservative measures as well as a review of indications for surgery. Each class consists of up to 20 people and is 1 hour in duration, allowing time for questions. Referrals are reviewed for appropriateness prior to booking based on clinical information provided and attached report for weight-bearing knee x-rays. Handouts are provided by email at the time of booking or in-person at the class. At the conclusion of the class, patients choose whether they wish to proceed to an initial assessment at the RAC or further pursue conservative treatment. A voluntary and anonymous satisfaction survey is collected. Patients may subsequently contact the clinic directly within the year following the class to request an initial assessment at the RAC if they fail to manage adequately with conservative measures. Data collection is ongoing. Preliminary results indicate a very high patient satisfaction rate. The majority of patients, 63%, chose to further explore the conservative measures reviewed during the session while 37% requested to proceed with an initial assessment at the RAC site. Impact on the waitlist for assessment and post-assessment outcomes for these patients will be examined. Callback rates will also be tracked. The Knee Osteoarthritis Education Session is an innovative option to help address increased wait times for initial assessment at Hip and Knee RAC sites. This program allows patients with mild to moderate knee OA to have a greater understanding of evidence-based non-surgical treatment options as well as indications for surgery in a timelier manner. This provides patients with the opportunity to fully optimize conservative measures before opting for an individual assessment at the RAC. The process also helps streamline patients who have end-stage joints and/or have exhausted non-surgical alternatives for an initial assessment at RAC.

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