Who Does What in Hand Osteoarthritis Care? A Qualitative Study of Boundary Work Between Rheumatologists and Occupational Therapists in Norway

Silje Zink,1,2 Ingvild Kjeken,1,2 Marte Feiring1,2 1Diakonhjemmet Hospital, REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases, Health Service Research and Innovation Unit, Oslo, Norway; 2Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, NorwayCorrespondence: Silje Zink, Diakonhjemmet Hospital, REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases, Health Service Research and Innovation Unit, Postboks 23 Vinderen, Oslo, 0319, Norway, Email silje.zink@diakonsyk.noPurpose: The pressure on professionals within the healthcare workforce is increasing due to staffing shortages, economic demands and changing care models. Through boundary work theories, our study explores how task-shifting in hand osteoarthritis (OA) care impacts the professional boundaries and division of labor between rheumatologists and occupational therapists (OTs) in Norwegian specialist healthcare.Methodology: Seventeen semi-structured qualitative interviews were conducted at two hospitals in Norway. Participants included ten rheumatologists and five OTs. Data were analyzed using reflexive thematic analysis.Results: The analysis resulted in three themes (1) Forms of responsibility and task transfers, (2) Circumventing the rules to ensure efficient practices and appropriate patient care, (3) Broadening and specializing; movement of professional demarcations. Overall, we found that medical tasks in hand OA care are increasingly delegated to, and adopted by, OTs, blurring the rheumatologist-OT boundary. Some of the task delegations skirted Norwegian legal boundaries, in efforts to streamline clinic operations. OTs expanded their scope of practice by adopting new tasks, whereas rheumatologist increased their specialist status by shedding unwanted tasks.Conclusion: Task shifting between rheumatologists and OTs in hand OA care was characterized by boundary blurring activities. The results support a shift in hand OA management from rheumatologists to OTs.Keywords: professional boundaries, boundary work, interprofessional collaboration, hand osteoarthritis