Current status of the rheumatologists’ workforce in Latin America: a PANLAR collaborative study

Fernández-Ávila, Daniel G.; Patiño-Hernández, Daniela; Kowalskii, Sergio; Vargas-Caselles, Alfredo; Sapag, Ana; Cachafeiro-Vilar, Antonio; Meléndez-Muñoz, Lucia; Santiago-Pastelín, Carlos; Graf, César; Rossetto, C.N.; Palleiro, Daniel; Trincado, Daniela; Fernández-Ávila, Diana; Arrieta, Dina; Reyes, Gil; Baez, Jossiel Then; Ugarte‐Gil, Manuel F.; Cardiel, Mario H.; Colman, Nelly; Chávez, Nilmo; Burgos, Paula I.; Montúfar, Rubén; Sandino, Sayonara; Fuentes-Silva, Yurilís; Soriano, Enrique R.

doi:10.1007/s10067-020-05555-w

Cited by 29 publications

(20 citation statements)

References 30 publications

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“…Organizations such as the International League of Associations for Rheumatology, which includes the American College of Rheumatology, have service to the global rheumatology community as one of their missions and could provide leadership for such initiatives ( 35 , 36 ). Although this study focused on the experiences of African clinicians, these findings are applicable to resource‐limited regions worldwide, even to rural communities in better resourced countries ( 37 , 38 , 39 ), and are increasingly relevant to rheumatologists as international travel and globalization expand. Initiatives addressing identified concerns can contribute to reducing health disparities in rheumatology care all over the world.…”

Section: Discussionmentioning

confidence: 99%

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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Objective Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. Methods African physicians who self‐identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L‐HDI versus MH‐HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. Results Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L‐HDI; 14 MH‐HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L‐HDI versus 43% MH‐HDI), compounded by financial restrictions (reported by 93% L‐HDI versus 64% MH‐HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L‐HDI countries and MH‐HDI countries. Conclusion The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L‐HDI countries.

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Section: Discussionmentioning

confidence: 99%

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Hitchon

Mody

Feldman

et al. 2021

ACR Open Rheumatology

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“…A recent survey of the Latin American rheumatology workforce by the PANLAR collaborative group showed that on average in Latin America, there is 1 rheumatologist per 106,838 habitants; however, this rate goes as low as 1 per 640,648 habitants in countries like Nicaragua. 17 Although almost 1 in 4 rheumatologists in Latin America combine a private and public practice, the majority of rheumatologists practice in a private setting, which might further limit the access to patients in a region where there are severe inequalities and a large sector of the population depends on informal unemployment. 17,18 The shortage in the rheumatology workforce is one of the main barriers of access to care and, as shown by Fernández-Ávila and colleagues, 5 the ongoing pandemic has most likely worsened this.…”

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confidence: 99%

“…17 Although almost 1 in 4 rheumatologists in Latin America combine a private and public practice, the majority of rheumatologists practice in a private setting, which might further limit the access to patients in a region where there are severe inequalities and a large sector of the population depends on informal unemployment. 17,18 The shortage in the rheumatology workforce is one of the main barriers of access to care and, as shown by Fernández-Ávila and colleagues, 5 the ongoing pandemic has most likely worsened this. Although expansion of the Latin American rheumatology workforce is needed to provide high-quality care, the increased use of telemedicine caused by the pandemic may well provide better access and represent an important solution given the concentration of specialists in main cities.…”

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confidence: 99%

“…Although expansion of the Latin American rheumatology workforce is needed to provide high-quality care, the increased use of telemedicine caused by the pandemic may well provide better access and represent an important solution given the concentration of specialists in main cities. 17 The COVID-19 pandemic has drastically affected the practice of rheumatology in Latin America and beyond, and there is a need to better understand its impact even past the first peaks. Despite the ongoing challenges, the rapid response of healthcare systems and physicians to the pandemic is encouraging and has precipitated changes that will enhance the delivery of care to our patients beyond the pandemic.…”

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confidence: 99%

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The COVID-19 Pandemic and Rheumatology: Impact on Providing Care in Latin America and Around the World

Sattui

Robinson

2021

J Rheumatol

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“…Despite this, the interest of doctors in specialist rheumatology has been declining. This imbalance is likely to be re ected in the offer and demand for consultations in this specialist area where there is an aging population and the treatment of rheumatic diseases (such as arthritis) is characterized by an ever-increasing complexity (1,22,33) .…”

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confidence: 99%

Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

Serratto

Kowacs

Kowalski³

2021

Preprint

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Background In recent years, due to the increased incidence of rheumatologic diseases, the demand for consultations in rheumatology has risen. In the Brazilian public health system, patients with rheumatologic complaints are referred from primary care to specialized consultation, and must wait in a waiting list for the specialized care. In 2015, the waiting time for the first consultation in rheumatology, in Curitiba- Brazil, was 600 days. In attempt to reduce this time, in-person and remote screening was implemented that same year in a healthcare service in Curitiba. From 2015 to 2019 the variation in the number of patients in waiting lists for their first rheumatology consultation and the length of the waiting period for their first referral was evaluated. Methods Observational study in a time series. The patients in the study were referred to a primary healthcare center for an assessment of rheumatology in Curitiba, Brazil. The data was analyzed based on the first consultation with the rheumatologist. The variables were the number of patients in the waiting list and the waiting period for the appointment with the doctor. The research was carried out through a computerized system called “e-saude”[electronic health] runed by the Health Secretary of the Municipality of Curitiba. A comparison was made between the period of 2013–2015, in a model for treatment without screening, and 2015–2019, when the in-person and remote screening first began. Results Between 2015 and 2019 there was a reduction in the waiting list of 6,429 patients to 25 patients, while there was an average of 56.5 patients in the last two years;. With regard to the waiting period for the first appointment with the rheumatologist in 2019, there was a reduction of 600 days to a minimum of 4 days and a maximum of 52 days. Conclusion Both in-person and remote screening for asynchronous electronic consultations for rheumatologist in Curitiba led to a reduction in the waiting time and number of patients for the first appointment with the rheumatologist, proving to be a useful method for reducing the time and number of patients in the waiting list for a specialized consultation.

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Current status of the rheumatologists’ workforce in Latin America: a PANLAR collaborative study

Cited by 29 publications

References 30 publications

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study

The COVID-19 Pandemic and Rheumatology: Impact on Providing Care in Latin America and Around the World

Screening in rheumatology: the impact on the everyday experience of patients in the Brazilian public health system

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