The Joint Clinic – initiation and programme evaluation of a new clinical service at Dunedin Hospital

Principal Investigator: Associate Professor Haxby Abbott

Co-Investigators: Dr Helen Harcombe (Dept of Surgical Sciences; Dept of Preventive & Social Medicine), Associate Professor David Gywnne-Jones (Dept of Surgical Sciences); Dr Cathy Chapple (Dept of Surgical Sciences; School of Physiotherapy); Anne Worsnop (Southern District Health Board); Lynda McCutcheon (Southern District Health Board); Chris Crane (Southern District Health Board); Liam Hutton (Southern District Health Board)

In healthcare systems with free public access to healthcare, such as New Zealand, there are circumstances wherein patients referred by general medical practitioners (GPs) for orthopedic specialist consultation may not be offered a consultation, because demand exceeds supply. Thus, clinical prioritization is necessary. In our hospital system, unmet need, defined as the proportion of patients declined orthopaedic surgical consultation over all patients referred by their GP for consultation, had ranged from 26.8% to 44.0% in the four year period prior to our proposal of an innovative service to address that unmet need by managing appropriate patients with OA non-surgically.

To address unmet need for orthopaedic consultation in patients with hip or knee osteoarthritis, we initiated and proposed a therapist-led clinic offering best-practice non-surgical management of osteoarthritis, including and outpatient physical therapy treatment.

The objective of this study was to report an end-to-end program evaluation of an innovative new service to manage unmet need in patients with hip or knee osteoarthritis (OA), named ‘The Joint Clinic”. The program evaluation comprised of a proof of concept evaluation, implementation evaluation, process evaluation and outcomes evaluation, using mixed-methods health services research methodology.


This research was funded by the National Health Board of New Zealand and the Southern District Health Board. Associate Professor Abbott was supported in part by a Sir Charles Hercus Health Research Fellowship from the Health Research Council of New Zealand.


Abbott JH, Harcombe H. The Joint Clinic: Programme Evaluation of a clinical service delivered by the Orthopaedic Outpatient Department, Dunedin Hospital. Final Report to the Southern District Health Board. March 2014. ISBN 978-0-473-28966-9


Department of Surgical Sciences Orthopaedic Surgery University of Otago Dunedin School of Medicine