Physios key to shorter waitlists
(Article from The Press, January 19, 2024)
Lynn Downes doesn’t need prompting to get up and dance.
The 73-year-old has spent the holidays running around after her seven grandchildren despite, a year ago thinking she might have been facing a hip replacement about now.
Downes had her right hip replaced in 2021, then her left side began playing up a year ago. “I thought, ‘Oh, gosh, here we go.’”
It had taken two referrals from her GP in 2021 before she was scheduled for surgery. Her pain had worsened, and she didn’t fancy joining the treatment queue again.
That queue has been an ongoing headache for Te Whatu Ora-Health NZ. As of November, more than 1500 people had been waiting more than a year for orthopaedic treatment.
Traditionally, the standard treatment process meant a patient referred by their GP went straight to an orthopaedic surgeon to be assessed. Now a Wellington pilot allowing orthopaedic physiotherapists to assess patients in the first instance has reduced treatment times by an average of 75 %.
In Wellington, patients are now waiting an average of 40 days for an initial spinal assessment, rather than 180 days in December 2019, while hip or knee complaints are being assessed in about 45 days. In August 2021 these patients were waiting 165 days.
Downes admits she was sceptical of the approach at first, but the exercises have allowed her to sleep without pain and keep pace with her school-aged grandchildren.
“She went over my history, the X-rays…She gave us some exercises and a pathway so I could contact her if my symptoms got worse,” Downes said.
“It’s a much better route. If things got worse, the physio would then contact the surgeon.”
Her treatment is ongoing, but she said she hoped to avoid surgery.
In Wellington, the pilot has been led by expert physiotherapist Sarah Francis, who said more than 600 patients had been through the programme since September 2022, at Wellington and Kenepuru hospitals and Kāpiti Health Centre.
Of course in some cases, surgery would be unavoidable, Francis said. But there was no need for every patient’s first assessment to be done by a surgeon.
“Part of this project is about making sure people get non-surgical care earlier. The sooner we intervene for people with, particularly conditions like osteoarthritis, we can prevent progression to joint replacement,” Francis said.
Patients were happy, too – 86% felt confident in being assessed this way, and fewer than 5% were referred back into the system after one year. Last August, Te Whatu Ora said it wanted to treat all orthopaedic patients who had waited more than a year by June 30. This was still the goal, planned care and cancer programme director Ian D’Young said, and good progress was being made. It was forecast that more than 14,000 patients were in that category, and by December 3 that number had come down to 5,222, he said. But for some it’s too late.
Wellington man David Garlick, 25, was turned away from the public system after two years of bouncing around appointments seeking help for a condition causing painful excess bone growth on a femur.
For him, surgery was unavoidable, but the time spent languishing in the public queue meant his condition worsened, taking an enormous toll on him and his fiancé. “It was a waste of my time, their time, everyone’s time.” It also left him facing $30,000 private medical bill, only avoided after a surgeon from the Auckland-based Aotearoa Charity Hospital read about his ordeal in The Post and offered to operate for free.
Garlick now needs the same surgery on his other hip, which he also hopes to get done through the charity hospital.
D’Young said Te Whatu Ora appreciated the impact of treatment delays “and we are working hard to put in place systems and processes so improvements to waiting times are made”.
Author: Rachel Thomas, The Press, 19 January 2024