Improving access to care and treatment for patients with hip and knee pain at the primary/secondary care interface

Muscle, joint and bone (MSK) conditions are the most commonly reported conditions in Wales, that individuals have to live with, and which prevent them from doing what they want during their everyday lives.

Because the number of elderly people in the population is rising, the impact of these problems and the need for treatment is increasing. A journey of what treatment a patient with an MSK condition may expect to receive, when they can expect to receive the treatment and by whom, is known as a care pathway.

A new care pathway for MSK conditions was described in a government document in 2006. This MSK care pathway has shortened the amount of time a patient needs to wait for treatment but the care that one patient to another receives remains inconsistent and needs to be changed to meet with what patients want and need.

Therefore, to understand this better and so that the treatment offered for MSK conditions is the correct one, there is a need to look at this problem in more detail. This means collecting information from different places and combining it to come up with solutions of how treatment can be more helpful and make best use of the money available in the NHS.

The part of the care pathway we will study in this project is from when a patients own doctor writes a referral letter and the patient is on a waiting list, to a time point after the patient has been seen and treated by that specialist. There are a number of MSK conditions and some of the most common reported ones locally and nationally are related to the hip and knee.

Therefore, to be deliverable and have the highest chances of being successful in terms of recruitment and project feasibility, this study will focus on patients that are referred for hip and knee pain by their GPs.

The questions that need to be answered are:

1- Based on the information from websites, government documents, scientific reading material and patient experiences of treatment, how good are current care pathways for patients with knee and hip pain, when being referred a specialist for treatment?
2- What is the correct information that a patient's doctor needs to give to the specialist to make sure the patient receives the best care?

Methods: Three different methods will be used that are then combined so that a new care pathway can be designed. The work for this project is divided into four parts.

Part 1: Combining evidence from scientific articles about care pathways and patient needs, websites and government documents to produce a report about what parts of the pathway work well already.

Part 2: Participants will be interviewed twice to find out what type of help they need to live with their MSK condition, what type of treatment they expect and how satisfied they are with treatment, following the current pathway. The first interview will be when their doctor first sends a referral letter and the patient is waiting to see the specialist, and the second interview after they have had their treatment with the specialist. We will look for differences in their responses between these time points.

Part 3: The words used in the referral letter will be analysed using special computer software that can be trained to recognise medical terms and phrases that are regularly used. It also gives these word and phrases a code. This word 'data' is then stored in an organised way so that it can be studied further using mathematical techniques. The referral letters will also be correlated with patient reported outcomes measures before and after treatment. This gathered information will contribute to part 4 in helping to produce a tool to assist doctors in making decisions about who to refer to and a form to make sure they send the correct information.

Part 4: The findings from parts 1-3 will be combined so that a detailed description of a design for a new care pathway is produced. This will also help develop a tool to assist doctors in making decisions about who to refer to and a form to help them send the correct information. The combined evidence based information will help patients in receiving the best treatment.

These findings will be given to patients to help them understand the type of treatment they may receive and who may give them that treatment. These findings will also be used by your doctor and other healthcare professionals. Finally the information can be used by people who make decisions about the types of treatment that should be given based on the best evidence.