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Bristol Bones and Joints Health Integration Team review of 2014-15

11 May 2015

Directors Dr Emma Clark, Professor Ashley Blom and Professor Sarah Hewlett give an update on the 2014-15 activity of the Bristol Bones and Joints Health Integration Team (HIT).

The Bones and Joints HIT covers three disease areas: osteoarthritis, osteoporosis and inflammatory arthritis, united and underpinned by three themes of patient self-management, patient and public involvement and information technology.

Our main achievement in osteoarthritis has been to increase the proportion of older patients receiving cemented hip replacements from 40 to 92 per cent across Bristol. This has resulted in better outcomes for patients and savings at North Bristol Trust of £170,000 per year. We are working with the West of England Academic Health Science Network to take this forward on a regional scale. Our research priority is surgical infection, with a randomised control trial in Bristol.

In osteoporosis, we have developed patient-based quality indicators for the pan-Bristol bone-densitometry DXA scanning service. We ran a meeting for Bristol osteoporosis specialists and dentists to discuss joint approaches to osteonecrosis of the jaw. We continue to have bi-annual meetings to share information and expertise, and are working on incorporating vertebral fractures into the commissioned Fracture Liaison Service across Bristol. Our research priority is improving adherence to osteoporosis medication.

We continue to use the standard drug monitoring programmes that we have developed for inflammatory arthritis, in place across the city in secondary and primary care. The new rheumatoid arthritis patient pathway in University Hospitals Bristol, based on review and pragmatic implementation of current best evidence in consultation with staff and patients, won a national Best Practice Award from the British Society of Rheumatology. North Bristol Trust is now also developing a pathway.

Local clinical commissioner leads for long term conditions and self-care are supporting our research priorities in this area. We are scoping self-management services across the HIT to improve access. Our current research is to understand the self-management needs of men with rheumatoid arthritis; to develop ways of supporting patient activation into self-management, and a randomised control trial of cognitive behavioural approaches to fatigue self-management, delivered by the clinical team and recruiting from both trusts, as well as nationally. Our research aim is to develop and test rheumatology team training to enhance self-management during routine consultations.

We held a second patient and public consultation day in April 2014, in which rheumatoid and osteoarthritis patients discussed patient involvement, self-management and research priorities. The next consultation day in June 2015, will focus on how to increase patient involvement in teaching and research.

We are developing the initial ‘single point of entry’ website for patients, clinicians and researchers across Bristol, offering local information on musculoskeletal disease, care pathways and research. This will be tested by patients at the June meeting.

Bristol Bones and Joints Health Integration Team review of 2014-15
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