Search

Vandana Ahluwalia,1 Taucha Inrig,2 Tiffany Larsen,3 Rachel Shupak,4 Tripti Papneja,1 Arthur Karasik,5 Carol Kennedy,2 Katie Lundon6 1Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada; 2Musculoskeletal Health and Outcomes Research, St. Michael’s Hospital, Toronto, ON, Canada; 3Department of Physiotherapy, Headwaters Healthcare Centre, Orangeville, ON, Canada; 4Division of Rheumatology, Department of Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada; 5Independent Rheumatology Practice, Etobicoke, ON, Canada; 6Continuing Professional Development, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaCorrespondence: Vandana AhluwaliaIndependent Community Rheumatology Practice, 314-40 Finchgate Boulevard, Brampton, ON, Canada, L6T 3J1 Tel +1 905-799-1850 Ext 221Fax +1 905-799-8040Email a7mad.al0rabi@gmail.comPurpose: This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices.Materials and Methods: Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period.Results: Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model.Conclusion: The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.Keywords: health service accessibility, interprofessional practice, rheumatology, patient satisfaction, quality improvement, extended role practitioner, integrated delivery systems, model of care

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