New 18 Week Arthritis Commissioning Pathway, UK

The Rheumatology Futures Project and the Department of Health have launched a new 18-week commissioning pathway for inflammatory arthritis (IA).


The pathway, that can be viewed HERE takes account of the recommendations of the recent Kings Fund report, will be a vital resource for commissioners of rheumatology services and clinicians considering service redesign as NHS organisations look to implement the NICE clinical guidelines on rheumatoid arthritis and the recommendations of the soon to be published National Audit Office report.


The pathway has been developed with the help of many healthcare professionals drawn from all disciplines and patient and professional organisations working with the Department of Health. The inflammatory arthritis commissioning pathway forms part of the package of more than 50 pathways, spanning a wide range of conditions and diseases, which have been developed as part of the Department of Health's 18-week initiative.


The Rheumatology Futures Project, who commissioned the pivotal research by the King's Fund, are now working next to add an innovative 'patient pathway' layer to the commissioning pathway, which will outline what services a patient can expect to be provided with along a pathway of care. This approach will take into account the service needs and expectations of patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis (three of the most common forms of IA).


Susan Oliver, Chair of the Royal College of Nursing Rheumatology Group and Joint Chair of the Rheumatology Futures Group said:



"Commissioners face immense challenges in preparing a comprehensive package of health and social care services for their population across a wide range of disease areas. This is often done with only a limited knowledge of the specific factors that need to be considered for every disease area. The IA Commissioning Pathway identifies the core generic needs of inflammatory arthritis patients as well as the more detailed commissioning evidence required to ensure an effective pathway of care. The pathway also provides a comprehensive package to enable three key inflammatory arthritis conditions to benefit from high calibre commissioning."


Alan Nye, Elective Care Clinical Advisor from the Department of Health who was involved in producing the 18 Week Pathway said:


"The Department of Health welcomes the addition of the inflammatory arthritis pathway to its suite of more than 50 high-volume symptom-based 18 Weeks commissioning pathways. Both commissioners and clinicians should find this an invaluable tool in ensuring patients are set on the right pathway of care, and are seen in the right place, at the right time, by the right person."


Ailsa Bosworth, Chief Executive of NRAS and Joint Chair of the Rheumatology Futures Group said:















"We know that people with inflammatory forms of arthritis experience many challenges when negotiating their healthcare needs. A wealth of research backed up by the recent King's Fund Report, has demonstrated that people want and need a clearer understanding of what they should expect in terms of healthcare provision to enable them to manage their condition effectively but also to empower them to be confident about when they should seek expert advice and support. Unfortunately, because of the significant variance in service provision across the country and poor understanding of the needs of patients, equity of access has continued to be a problem. We now have a solution that will encourage commissioners to address variances in provision and recognise high quality care for people with inflammatory forms of arthritis."


Notes


1. Inflammatory Arthritis: Fast Facts


Note: Inflammatory arthritis is a term used to encompass a number of musculoskeletal conditions that are driven by an inflammatory component and include conditions such as Rheumatoid Arthritis (0.8-1% of the population), Psoriatic Arthritis and Ankylosing Spondylitis.



Rheumatoid Arthritis


- RA is a chronic, progressive, disabling condition affecting appx. 450,000 people in the UK with 12,000 newly diagnosed p/a.


- When untreated, the disease can progress rapidly, causing swelling and damage to cartilage and bone around the joints. Any joint may be affected but it is commonly the hands, feet and wrists. It's an auto-immune disease with no known cause or cure.


- The main symptoms of RA are severe pain, stiffness, fatigue and loss of mobility.


- 42% of RA patients are registered disabled within 3 yrs of diagnosis. 80% are moderately to severely disabled within 20 years.


- RA affects approximately three times more women than men.


- The onset of RA can occur at any age with around 12,000 children under the age of 16 with a juvenile form of the disease.


Psoriatic Arthritis


- Psoriatic arthritis (sometimes known as PsA) is a disease where joints around the body become inflamed and sore.


- It can make moving about difficult and painful. People who have psoriatic arthritis also have (or will develop) the skin condition psoriasis.


- Psoriasis can develop in the teenage years, but psoriatic arthritis usually happens later, often around the age of 40.


- Psoriatic arthritis is quite unusual: about one in 50 people have psoriasis, and of these, only about one in 14 will develop psoriatic arthritis.


- Children can develop psoriatic arthritis, but this is very rare.


- Psoriatic arthritis typically causes pain in the elbows, knees, hands, feet, and the base of the spine, but it can affect any of the joints in your body.


- It may affect just one or two joints, sometimes more. It can also affect tendons and ligaments around the joints.



Ankylosing Spondylitis


- Ankylosing Spondylitis is an inflammatory arthritis that chiefly affects joints in the spine and the sacroilium in the pelvis.


- At the start, AS usually causes low backache and stiffness and may be misdiagnosed as common back pain. Aches and pains in the neck, shoulders and hips, or in the thigh (like sciatica), may follow.


- In a few cases, and especially in children, the first complaint may not be in the back at all, but in the hip or knee, or in the leg. The smaller joints of the hands and feet can be attacked.


- In its early stages AS causes considerable pain, but effective treatment is available to relieve this.


- Iritis (inflammation of the iris which forms the pupil) occasionally occurs.


- Other rare complications, affecting less than 1 patient in 100, may occur. These include the heart, lung and nervous system.


2. The Rheumatology Futures Project


- The Rheumatology Futures Project is an organisation that is made up of patient organisations (including National Rheumatoid Arthritis Society, Arthritis Care, and the Arthritis and Musculoskeletal Alliance), medical (British Society of Rheumatology and Primary Care Rheumatology Society) nursing (Royal College of Nursing) and allied health care professional groups (British Health Professionals in Rheumatology).


- The pharmaceutical industry are supporting this project with lead political and government affairs advisers representing Abbott, Bristol Myers Squibb, Roche, Schering Plough, UCB and Wyeth.


Source
The Rheumatology Futures Project