The Chronic Disease Model

Osteoarthritis Management Toolkit

Living with Osteoarthritis

According to the Employer-Provider Interface Council (EPIC), in their paper titled Mobility as a Framework for Managing Osteoarthritis in a Holistic Chronic Disease Model, a paradigm shift is needed to improve outcomes in the management of osteoarthritis. Clinicians, patients, payors and other stakeholders would have to view OA as a chronic condition, not a disease that can be cured.

To accomplish this, the authors advocate for the use of chronic care model (CCM), which has been used successfully with other conditions including diabetes, cardiovascular disease and depression. Research suggests that this type of patient-centered chronic care model results in improved outcomes, lower health care costs, and features:

  • Promotion of patient self-management
  • Mobilization of community resources
  • Decision support and access to clinical information for healthcare providers
  • Use of evidence-based protocols 
  • Reorganization of health care delivery

The first and most important step in managing osteoarthritis is education. People with OA need to understand that they have a chronic and progressive condition and that lifestyle management plays a critical role in slowing disease progression. Otherwise, they may not make necessary lifestyle changes.

The CCM’s multi-pronged approach includes this emphasis on patient education and self-management, along with focus on prevention, early intervention, and promoting evidence-based best practices. (EPIC p. 9)

Call to Action

The EPIC task force recommends that clinicians, payors, employers and community health organizations take the following specific actions:

  • Develop improved public and patient information materials
  • Develop informational materials for nonmedical stakeholders, such as employers and insurers
  • Design benefit plans to support and promote prevention and early intervention strategies
  • Promote biomechanical joint evaluations by specifically trained physical therapists or other professionals
  • Adopt drug treatment algorithms that emphasize long-term safety
  • Use functional outcomes as measurements of treatment efficacy
  • Promote the use of more meaningful metrics in future clinical trials
  • Better information sharing among primary care, specialists, and other licensed health professionals
  • Expanded role for pharmacist in managing pharmacotherapy (screening, counseling, medical care collaboration) (EPIC p. 23)

OA & Comorbidities

Comorbidities are common in people with osteoarthritis. In fact, it is estimated that 59% - 87% have at least one significant chronic condition and 31% have five or more. The most common chronic conditions in people with OA are cardiovascular disease, diabetes and hypertension. These conditions significantly impact an already compromised quality of life, making self-management of each condition difficult.

The rate of metabolic syndrome, known as the combination of obesity, diabetes, hypertension and dyslipidemia, is higher in those with OA as well (59%) when compared to those not suffering from the disease (23%).

Depression and pain commonly occur together, so many people with OA suffer from this condition as well. Depression in combination with OA can lead to poor outcomes due to lack of desire or energy for physical activity and compromised ability to follow a treatment plan for either condition.

Understanding these comorbidities is important as you try to identify modifiable risk factors and key areas to focus your efforts. (OARSI p. 19)