State Public Health Approaches to Addressing Arthritis

Description

Arthritis has a profound economic, societal and personal impact. Medical care costs and earnings losses among adults with arthritis were over $303 billion in 2013.(1) Arthritis affects more than one in four adults in the United States, or 54 million+ adults which will increase to 78 million by 2040, and limits 24 million in performing daily tasks.(2) One in 3 adults in rural areas has arthritis and over half of these have arthritis-attributable activity limitation.(3) Arthritis is significant, not just because of its negative impact on function, physical activity and quality of life, but because it is associated with leading causes of death, such as heart disease and diabetes.(4,5) Arthritis can also limit physical activity, which is recommended management for all of these conditions. The rising number of adults with arthritis and associated pain and activity limitations, and its ability to complicate the management of other chronic conditions and risk factors responsible for death, presents a critical public health problem.(2) Increased physical activity and participation in self-management education programs can help adults with arthritis reduce or manage pain and limitations.(6) The American College of Rheumatology's 2012 osteoarthritis management guidelines recommend exercise as a key, nondrug strategy to manage arthritis symptoms.(7) Adults with arthritis can reduce pain and activity limitations by up to 40% by engaging in PA and other management strategies.(8) Still, 1 in 3 adults with arthritis are inactive and many may not be aware of available, proven community-based programs that can help manage arthritis.(2) Evidence suggests adults are more likely to attend an education program and engage in physical activity when recommended by a healthcare provider.(2,7,9) Because physicians' advice is respected and physician-patient encounters can be frequent among adults diagnosed with arthritis, even if primarily for co-occurring conditions or age-related screenings or check-ups, these encounters and other opportunities can be used to: 1) counsel about PA, including walking, and 2) refer adults with arthritis to arthritis-appropriate, evidence-based interventions (AAEBIs) for physical activity and self-management education.(9,10) This Notice of Funding Opportunity's (NOFO) purpose addresses these findings and trends by soliciting applicants to implement state-based approaches to increase self-management behaviors and improve the quality of life of adults with arthritis. This 5-year funding opportunity is intended to leverage existing partnerships, systems and resources to establish complementary community and healthcare provider approaches to improve arthritis management and reduce arthritis burden. The applicant is to sustainably disseminate and thereby increase the availability of and participation in CDC-recommended AAEBIs, adopt innovative and systems-based approaches that will help establish or enhance healthcare provider patient counseling about PA, including walking, and referral to physical activity AAEBIs and promote state level walking initiatives addressing the unique needs of adults with arthritis. In addition to activities addressing the applicant's target adult population, the applicant is expected to engage underserved adult populations in the state to address health disparities. Successful applicants are expected to be those with direct access to a sizeable percentage of the state population and who possess the capacity to carry-out activities that will have measurable, statewide impact on arthritis outcomes and associated health behaviors. This NOFO is expected to result in awards for 12-15 state programs addressing arthritis management using the strategies and approaches described throughout the NOFO. Up to one award will be made per state. (1) Murphy LB, Cisternas MG, Pasta DJ, Helmick CG, Yelin EH. Medical expenditures and earnings losses among US adults with arthritis in 2013. Arthritis Care Res (Hoboken). 2017 Sep 26. Doi: 10.1002/acr.23425 (2) Barbour KE, Helmick CG, Boring M, Brady TJ. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:246-253. DOI: http://dx.doi.org/10.15585/mmwr.mm6609e1. (3) Boring MA, Hootman JM, Liu Y, et al. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation by Urban-Rural County Classification - United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:527-532. DOI: http://dx.doi.org/10.15585/mmwr.mm6620a2. (4) Qin J, Theis KA, Barbour KE, Helmick CG, Baker NA, Brady TJ. Impact of arthritis and multiple chronic conditions on selected life domains. United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64:578-824 (5) Theis KA, Brady TJ, Helmick CG. No One Dies of Old Age Anymore: A Coordinated Approach to Comorbidities and the Rheumatic Diseases. Arthritis Care Res (Hoboken). 2017;69(1):1-4. DOI: 10.1002/acr.23114 (6) Murphy LB, Hootman JM, Boring MA, et al. Leisure time physical activity among US adults with arthritis, 2008-2015. Am J Prev Med. 2017 June 7. [Epub ahead of print] doi: 10.1016/j.amepre.2017.03.017. PubMed PMID: 28601405. (7) Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64(4):465-74. doi: 10.1002/acr.21596. (8) Kelley GA, Kelley KS, Hootman JM, Jones DL. Effects of community-deliverable exercise on pain and physical function in adults with arthritis and other rheumatic diseases: a meta-analysis. Arthritis Care Res (Hoboken) 2011;63:79-93. (9) Barron MC, Rubin BR. Managing osteoarthritis knee pain. J Am Osteopath Assoc. 2007 Nov;107(10 Suppl 6):ES21-7. (10) Brady T. Enhancing clinical practice with community-based self-management support programs. P.M. Nicassio, Psychosocial Factors in Arthritis, Springer International Publishing Switzerland. 2016:255. DOI 10.1007/978-3-319-22858-7_15

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