Bristol Bones and Joints HIT looks back over 2017-18

Directors Dr Emma Clark, Professor Emma Dures and Mr Sanchit Mehendale give an update on the 2017-18 activity of the Bristol Bones and Joints Health Integration Team (HIT).

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

In osteoarthritis the infected arthroplasty service at North Bristol Trust continues to be a world-class referral centre with a multidisciplinary approach, thanks to the efforts of our HIT. The INFORM programme which we are leading, a randomised control trial of one versus two-stage revision of infected hip replacements, continues apace. The study brings together 14 NHS trusts and five universities and is funded by a £2 million NIHR grant.

In osteoporosis, we have developed new best-practice standards across Bristol for management of patients on long-term treatments for osteoporosis. We have worked on ensuring the same reporting information is on DXA scans, irrespective which hospital the DXA scan was performed.

In inflammatory rheumatological disorders we have developed and implemented the same referral proforma for patients with potential early inflammatory arthritis across Bristol and Weston. We have also updated our pan-Bristol shared-care guidelines for use and monitoring of disease modifying anti-rheumatic drugs (DMARDS) for GPs.

In self-management, we are aware access to psychological and self-management programmes is inequitable across trusts and conditions. Bristol Health Partners has given us £10,000 to try and improve this. Our research on self-management includes:

• improving support for the self-management of fatigue
• improving shared decision-making with professionals
• exploring the impact of some of the rarer conditions
• supporting patient activation into self-management

‘ESCAPE-pain’ is an exercise and self-management intervention to improve pain and function for people with hip and knee osteoarthritis. It’s now being trialled in local leisure centres delivered by exercise professionals, rather than hospital physiotherapists.

We held our fourth pan-Bristol patient consultation day on Wednesday 18 October. There were 40 patients and 14 clinical academic staff, who met at BAWA in Southmead, to discuss self-management in the three Bones and Joints HIT themes.

Our single point of entry website for patients, clinicians and researchers across Bristol, offering local information on musculoskeletal disease, care pathways and research is now in beta version. We are in the process of refining it with Kat Arnold, based on feedback from the self-management workstream. In addition we are supporting and helping develop an application to NHS Digital Test Bed to implement access to the website as part of a self-management app for patients with long-term conditions.