1. An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice
- Author
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Vandana Ahluwalia, Taucha Inrig, Tiffany L H Larsen, Katie Lundon, and Carol A. Kennedy
- Subjects
musculoskeletal diseases ,Community based ,medicine.medical_specialty ,genetic structures ,business.industry ,030503 health policy & services ,Journal of Multidisciplinary Healthcare ,Arthritis ,Diagnostic accuracy ,General Medicine ,medicine.disease ,Predictive value ,Triage ,Rheumatology ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Chart review ,Internal medicine ,medicine ,030212 general & internal medicine ,skin and connective tissue diseases ,0305 other medical science ,business ,General Nursing - Abstract
Vandana Ahluwalia,1 Tiffany L H Larsen,2 Carol A Kennedy,3 Taucha Inrig,3 Katie Lundon4 1Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada; 2Department of Physiotherapy, Headwaters Health Care Center, Orangeville, ON, Canada; 3Musculoskeletal Health and Outcomes Research, St. Michael’s Hospital, Toronto, ON, Canada; 4Office of Continuing Professional Development and the Department of Medicine, Faculty of Medicine, University of Toronto, ON, Canada Objective: To facilitate access and improve wait times to a rheumatologist’s consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision.Materials and methods: A community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model.Results: One hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7, range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).Conclusion: A well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA. Keywords: rheumatology, health services accessibility, interprofessional relations, community health services, integrated delivery systems
- Published
- 2019