Bristol Bones and Joints review of the year: 2015-16

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, underpinned by three themes of patient self-management, patient and public involvement and information technology.

We have developed the infected arthroplasty service at North Bristol Trust into a world class referral centre with a multidisciplinary approach. We are now leading a national consortium of 14 NHS trusts and five universities in the INFORM programme, a randomised control trial of one versus two-stage revision of infected hip replacements, funded by a £2 million NIHR grant.

In osteoporosis, we now routinely collect patient-based quality indicators for the pan-Bristol bone densitometry DXA scanning service. Our bi-annual meetings to share information and expertise continue, and we are working on incorporating vertebral fractures into the commissioned fracture liaison service across Bristol. Our research priority remains improving adherence to osteoporosis medication.

We have standardised drug monitoring programmes for inflammatory arthritis across the city in secondary and primary care. The British Society of Rheumatology award winning rheumatoid arthritis patient pathway in University Hospitals Bristol has been running for more than a year, and North Bristol Trust has now also developed a pathway. We are exploring ways of delivering best practice for patients with vasculitis and the connective tissue diseases in a unified way across both trusts and the Royal National Hospital for Rheumatic Diseases in Bath.

We have scoped self-management services across the HIT. While there are good programmes in some areas, access to psychological and self-management programmes is limited and inequitable across trusts and conditions. Our research is on understanding the self-management needs of men with rheumatoid arthritis, supporting patient activation into self-management, and a randomised control trial of cognitive behavioural approaches to self-managing fatigue.

‘ESCAPE-pain’, an exercise and self-management intervention to improve pain and function for people with osteoarthritis, which we developed with Professor Mike Hurley at Kingston University, won Royal Society for Public Health and British Society of Rheumatology awards. We worked with commissioners across the West of England Academic Health Science Network (WEAHSN) to bring the intervention into practice. This is becoming the intervention of choice for this patient group.

Our third patient consultation day in June 2015, attended by 28 patients and 10 senior staff, focussed on how to increase patient involvement in teaching and research. It provided insights into differences in service provision across the trusts, but with each demonstrating some excellent services.

Our single point of entry website for patients, clinicians and researchers across Bristol, offering local information on musculoskeletal disease, care pathways and research, was tested by 30 patients from across Bristol at the June meeting, and is being refined.

www.bristolhealthpartners.org.uk/bonesandjoints