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Knees Up Mother Brown! Marion Richardson. The St Albans and Harpenden Acupuncture Knee Clinic.

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Presentation on theme: "Knees Up Mother Brown! Marion Richardson. The St Albans and Harpenden Acupuncture Knee Clinic."— Presentation transcript:

1 Knees Up Mother Brown! Marion Richardson

2 The St Albans and Harpenden Acupuncture Knee Clinic

3 Why acupuncture? An ancient art Well tried & tested Cost effective Patient choice A last ditch attempt Local practitioners Safe

4 Cost-effectiveness Lindell (1999) o patients in GP setting o acupuncture OR hospital OP referral or procedure o acupuncture costs significantly less o average saving/patient £232 No UK studies specifically focussing on knee pain but back pain study (Thomas et al, 2005) incremental QALY costs compared favourably with other NHS approved treatments Reinhold et al (2007) Eur J Health Economics o Acupuncture + usual care cost effective in OA knee

5 Why acupuncture? An ancient art Well tried & tested Cost effective Patient choice A last ditch attempt Local practitioners Safe

6 Safety Yamashita et al (2006) o No serious adverse events reported o Minor side effects – worsening of pain, haematoma, dizziness o May be unrelated to physiological action of acupuncture per se White (2007) Evidence from UK o Negligible risk in hand of competent practitioners

7 Why acupuncture? An ancient art Well tried & tested Cost effective Patient choice A last ditch attempt Local practitioners Safe

8 Eastern or Western therapy? Dampness in the spleen meridian? OR Osteoarthritis of the knee?

9 Why OA knee? Common Debilitating Older population with co- morbidity NSAIDs can be harmful + lack of evidence of long-term effectiveness Surgery may be suboptimal, has relatively high rates of complications and is expensive - £5633 (PBC tariff 2008/9)

10 Is there research evidence? Is there research evidence? Large cohort, high quality RCTs o Vas et al (2004) Acupuncture vs a sham needle – better for pain, improved function and decreased use of diclofenac o Berman et al (2004) – Acupuncture improved function and pain relief compared with sham acupuncture and education control groups o Witt C et al Acupuncture significantly better than sham for pain and disability Systematic Review (White et al, 2007) Acupuncture significantly superior to sham and to no intervention in improving pain and function in severe OA knee

11 How are patients referred? Via MSK CATS Clear criteria o maximum tolerated analgesia o woken at night o restricted walking distance (eg 100 m) Contacted by MSK CATS ES physio Offered acupuncture & choice of surgery Appointment made by surgery

12 The clinics Nurse led Initial personal consultation ‘Trial’ session of acupuncture Group clinic Treatment protocol Assessment using MYMOP

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14 The clinics Nurse led Initial personal consultation ‘Trial’ session of acupuncture Group clinic Treatment protocol Assessment using MYMOP

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16 The clinics Nurse led Initial personal consultation ‘Trial’ session of acupuncture Group clinic Treatment protocol Assessment using MYMOP

17 The clinics Nurse led Initial personal consultation ‘Trial’ session of acupuncture Group clinic Treatment protocol Assessment using MYMOP

18 Treatment protocol 4 sessions at weekly intervals Reassess and either o continue with manual acupuncture o add electroacupuncture and reassess Treatments at extending intervals MYMOP assessment at 6 months Maintenance every 6 weeks or less frequently

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20 Treatment protocol 4 sessions at weekly intervals Reassess and either o continue with manual acupuncture o add electroacupuncture and reassess Treatments at extending intervals MYMOP assessment at 6 months Maintenance every 6 weeks or less frequently

21 Is it working? Numbers treated to end of August o 63 patients (44F, 19M) o 98 knees (35 both) o Age range Numbers still being treated o 52 patients o 80 knees

22 Success contd. Those referred back to MSK CA(T)S o 1 worse after treatment o 6 insufficient symptom relief o 1 wanted surgery ( despite considerable improvement) o 1 initial improvement not maintained o 2 repeated DNA o 1 problems getting to surgery o 1 GP disapproved of acupuncture!

23 Success contd. Saving money? o 1 TKR = 282 treatments o 28 patients for first 6 months o 35 patients a year AT LEAST longer term o Both knees = 1 treatment o 12 knees maintained for 1 year and avoiding TKR = an annual saving against tariff of £67,356 Other potential savings o OPD consultations o Physiotherapy interventions o Medications

24 MYMOP scores Overall score (max 24, min 0) o Pain (0-6) o Stiffness (0-6) o Activity (0-6) o Wellbeing (0-6) Drugs for condition Importance of cutting down

25 MYMOP scores difference at 4 weeks

26 What are the perceived benefits? Reduce the demand for outpatient, inpatient and day case treatment and so either save the cost of those activities and/or reduce waiting times Reduce the need for operative interventions especially knee surgery Reduce referrals to the West Herts physiotherapy service and thereby reduce waiting times Promote a Secondary to Primary shift of care in line with the aims of government, Investing in Your Health and PCTs Enhance patient choice and ensure a service that is locally accessible to patients in line with the stated aims of the government and local health economy Reduce expenditure on medication

27 Let the patients speak… “In 2003 I was diagnosed with severe osteoarthritis in both knees and was told that the condition would deteriorate and my only recourse was painkillers and eventually replacement knees. The provision of acupuncture on the NHS has transformed this prognosis. Acupuncture eased the pain and discomfort to such an extent that I was able to take up regular exercise to strengthen my muscles. Nowadays, I rarely take painkillers and the flexibility in both knee joints has improved dramatically.

28 Attending the acupuncture clinic in the GP’s surgery is beneficial for several reasons: the surgery is local; the acupuncture is given as part of a treatment programme particular to each patient’s medical history; the patient has confidence that the acupuncturist is well-trained and has a medical background and patients feel more comfortable in familiar surroundings. Group sessions are therapeutic in encouraging patients to share their experiences. I feel privileged and lucky to have benefitted from acupuncture on the NHS and hope that it will continue and its availability become widespread throughout the country.” Valerie Lucien 18 August 2008

29 Acknowledgements Dr Jonathan Freedman, Parkbury House Pam Richmond – Nurse Acupuncturist Drs James Ferguson, Michael Cannell, Andy Cohen – the Midway Surgery St Albans Dr Mike Cummings - BMAS Medical Director Dr Saul Berkovitz - Consultant RLHH Katrina Power – Commissioning Lead West Herts PCT Dr Mark Bevis – MSK CATS GP Lead Sally Allan – Extended Scope Practitioner MSK CATS

30 Any questions?


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