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

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.