Scottish Public Health Network
A stakeholder health care needs
assessment of rheumatoid arthritis
A Conacher, M Perry, P Mackie
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Jane Gibson, Consultant Rheumatologist, NHS Fife
Lynne Shand, Consultant Rheumatologist, NHS
Grampian
Donna Hood, Clinical Nurse Specialist, NHS Greater
Glasgow & Clyde
Liz McIvor, Clinical Nurse Specialist, NHS Greater
Glasgow & Clyde
Duncan Porter, Consultant Rheumatologist, NHS
Greater Glasgow & Clyde
Jemma Pringle, Specialist Registrar, NHS
Lanarkshire
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Plus…
Janet Harkess, Head Occupational Therapist, Fife
Rheumatic Diseases Unit
Keith Slater, General Practitioner, NHS Highland
Jenny Snell, Government Affairs, National
Rheumatoid Arthritis Society
Neil McKay, Consultant Rheumatologist, NHS
Lothian
Mike McMahon, Consultant Rheumatologist, NHS
Dumfries & Galloway
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Content
• ScotPHN and needs assessment
• Background to rheumatoid arthritis needs
assessment
• Method
• Findings
• Next steps
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Scottish Public Health Network
Specific functions are:
• to undertake prioritised national pieces of work where
there is a clearly identified need;
• to facilitate information exchange between public
health practitioners, link with other networks and
share learning;
• to create effective communication amongst
professionals and the public to allow efficient coordination of public health activity; and
• to support and enhance the capabilities and
functionality of the SDsPH Group.
National needs assessment key part of work
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ScotPHN Needs Assessment
• Epidemiological
• Corporate
• Comparative
• Views of stakeholders (including patients and
public)
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Background – Policy and Evidence Context
Better Health, Better Care
Policy
Delivering
for Health
2002
2005
Public Health Institute for
Scotland - Needs
Assessment Report:
Rheumatoid arthritis in
adults
Evidence
Delivery Framework for
Adult Rehabilitation
2007
2008
NHS QIS Clinical
Audit of
Care in
Rheumatoid
Arthritis
Quality
Strategy
2009 2010
2011
Revised
SIGN 48
guideline
NICE
guidance on
management
of RA
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Background
• 2009 – Scottish Government asks ScotPHN
to consider a project looking at arthritis
• Arthritis appeared to be the main chronic long
term condition not being progressed in terms
of provision of services (with the exception of
psoriatic arthritis)
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Stakeholders
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Scottish Government
NHS Boards
Primary Care
Primary Care Rheumatology Society
Directors of Pharmacy / Scottish Medicines Consortium
NHS QIS (SIGN) (development of SIGN guideline concurrent)
NHS Education Scotland
Arthritis Care Scotland
Arthritis and Musculoskeletal Alliance (ARMA)
National Rheumatoid Arthritis Society (NRAS)
British Society for Rheumatology
Scottish Society for Rheumatology
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Method – usual ScotPHN project
methodology
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Project Group and Lead Author
Project Sponsor
Epidemiological assessment
Comparative assessment
Corporate assessment (Stakeholder interviews and
questionnaires)
• Stakeholder Group
Mini groups
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Objectives
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Project group agreed focus should be on rheumatoid arthritis
and should:
Map the policy area and current work being undertaken in this
area.
Seek to understand the interfaces with other specialities
(musculoskeletal (MSK), osteoarthritis etc).
Understand stakeholder interest.
Annotate and update the PHIS report (December 2002) on
rheumatoid arthritis.
Identify the inequalities resulting from current service provision
and consider rural and remote issues.
To make recommendations for future work.
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Areas of work
5 Groups were established with a lead to draft ‘mini’
reports:
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Initial referral and assessment
Chronic disease management
Rational approach to RA prescribing
Employment and societal impact
Remote and rural provision
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Main Findings
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Incidence and Prevalence
• The epidemiology in this area remains relatively
under developed.
• Generally, rheumatoid arthritis is 2 to 4 times more
common in women.
• About 1 in 4 patients with RA are work disabled at
diagnosis, rising to 1 in 3 at 5 years and approaching
1 in 2 at 15 years. Scotland has significantly higher
work disabled RA population than England.
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Number
Projected numbers of males with rheumatoid arthritis for 2010,
2015, & 2020, by selected age groups. Aged 16 years and over.
(Mid 2009 based.)
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
16-44
45-64
65-74
75+
2010
2015
2020
Year
http://www.arthritisresearch.org. Accessed 21/01/11
Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M et al. The prevalence of rheumatoid arthritis in the United
Kingdom: new estimates for a new century. Rheumatology 2002; 41(7): 793-800
General Register of Scotland Mid-2009 Population Estimates Scotland
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Projected numbers of females with rheumatoid arthritis for 2010,
2015, & 2020, by selected age groups. Aged 16 years and over.
(Mid 2009 based.)
14000
12000
Number
10000
16-44
8000
45-64
6000
65-74
4000
75+
2000
0
2010
2015
2020
Year
http://www.arthritisresearch.org. Accessed 21/01/11
Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M et al. The prevalence of rheumatoid arthritis in the United
Kingdom: new estimates for a new century. Rheumatology 2002; 41(7): 793-800
General Register of Scotland Mid-2009 Population Estimates Scotland
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Key findings
• Lack of robust data on management of RA across Scotland
• Delay occurs to time of diagnosis and treatment –
 shared care not as effective as could be
 results in long term disability
• Lack of awareness in general public compounds early
diagnosis and referral which are key to improved outcome for
patient
• Pharmaceutical therapy of rheumatoid arthritis has changed
considerably since 2002
 Need to understand what is effective use of pharmaceutical
therapy
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ScotPHN findings on stakeholder
needs assessment
It’s hard work…
• A lot of people to project manage
• Different styles
• Reconcile views within report
• A lot of recommendations
BUT…
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ScotPHN findings on stakeholder
needs assessment
• Better understanding of all stakeholder
view points
• Created ownership
• Enriched stakeholders’ understanding of
own and other parts of service
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Next steps for ScotPHN
• Finalisation of write through
• Economic analysis
• Piloting through National Planning
Forum
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Contact
Ann Conacher, ScotPHN Co-ordinator
(ann.conacher@nhs.net / 0141 354 2979)
www.scotphn.net
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