Chronicle in Dagens Medicine by Ingvild Kjeken, senior researcher at Diakonhjemmet Hospital and professor of occupational therapy at OsloMet and Kari-Jussie Lønning, hospital director, Diakonhjemmet Hospital.
In rheumatological departments, we take the government's call for task sharing seriously. We have moved responsibility for patients with osteoarthritis from doctors to other health professionals. But strict regulations prevent us from having the full effect of these steps.
Task sharing releases resources in the health service
Task sharing is one of the government's strategies to ensure citizens good and effective health services in the future as well. A cost -effective task sharing is to move tasks from health professionals with long education to those with shorter education. Another form is digital task sharing using mobile apps. Here, the responsibility is moved directly to the patient, who, when using customized apps, learns about their own illness, conducts training using videos and reminders, or monitors their own health in case of regular measurements of selected disease parameters. The latter allows patients to contact the health care system when the need arises, rather than meeting routine checks that are not always as useful.
Effective course of treatment for handrosis
Task sharing is well suited in the treatment of diseases where there are no cure, and where lifestyle changes are the core treatment. Handarchrosis is such a disease and affects almost half of all women and a quarter of men during their lives. The disease often causes pain, stiffness, problems with daily activities and reduced ability to work. Patients should mainly be treated in the municipal health service, but the offer there is deficient. Therefore, patients are increasingly referring to a rheumatologist or surgeon in the specialist health service. However, they do not have much to offer and often pass the patient on to an occupational therapist, who has good expertise in hand osteoarthritis.
In order to avoid this "detour", at the Diakonhjemmet Hospital and Martina Hansens Hospital, we conducted a study of a course in which patients with hand -arthritis come directly to the occupational therapist, who initiates recommended treatment. If there is any doubt about the diagnosis, the rheumatologist is consulted, and if necessary, the patient is referred to for assessment by a surgeon. With the support of the Research Council of Norway, we have evaluated whether this course is as effective and safe as a traditional rheumatologist's course (link to Lancet article https://authors.elsvier.com/a/1lf859ubhvvvgbi ). The results show that treatment response is equal in the two groups. The same is the number of negative events, which are few and not serious. The occupational therapy course also has lower costs, mainly due to fewer consultations with a rheumatologist and lower labor costs for occupational therapists. The patients' satisfaction with the offer is high and equal in the two processes. Therefore, the occupational therapy -led course has now been used at both hospitals.
However, it is important to avoid the number of referrals to the specialist health service increasing. With the support of the Dam Foundation, we have therefore in parallel the collaboration with the Norwegian Rheumatics Association and people with hand-arthritis to develop the Mastery app Happy Hands. In the app, patients with hand arthrosis are guided in performing exercise and changing work habits. During testing the app, we interviewed users. They said that the app gave them knowledge of their own illness and what they could do to master it themselves, and the courage and help to make the necessary changes. Data directly from the app showed that 75 % of users did regular hand exercises, and that pain, hand power and activity performance were noticeably improved after three months.
Our conclusion is that this app is effective first -line treatment for hand -arthritis. Patients can easily download it on the advice of a doctor, health care provider or acquaintances who have hand -arthritis themselves. This ensures access to recommended treatment with minimal use of resources in the health service. However, new and strict requirements for CE marking of patient apps such as medical equipment make the way to such a solution unnecessarily long and expensive.
Sustainable course is stopped by strict regulations
If you are to take the full effect of task sharing, responsibility for new tasks must be followed by the opportunity to implement them. In our study, we found that occupational therapists' lack of right to request X -rays slowed the opportunity to assess the need and reference to the surgeon. Requirements from a rheumatologist on the application for reimbursement of orthopedic aids, in this case support rail for the thumb adapted by an occupational therapist, also created unnecessary extra work and waiting time. Therefore, if one is to take full profit of task sharing, laws and regulations must be made more flexible to allow for effective redistribution of tasks.
The same applies to the process of CE marking patient apps in the lowest risk classes. In our Mastery app, we have collected information that is already fully accessible, and deliver this at the time the user himself chooses. That such an app must go through the same strict risk assessment as a hip prosthesis or an artificial heart valve is incomprehensible to us.
In Germany, they have taken the consequence of this and created a "fast-track" with rapid risk assessment of apps in low risk classes. We also need this in Norway. Patients must have quick access to new digital tools that can improve their health.
All this already knows the Minister of Health. Now we look forward to action in the area!
Here you can read the chronicle of Dagens Medisin.
