An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

Abstract

ObjectiveTo 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 methodsA 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.ResultsOne 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).ConclusionA well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

Extended Role Practitioners to Improve Access to Rheumatic Care: What is the Evidence in the Classification of Patients with Spondyloarthritis?

“…The results of the study are promising because ERP and rheumatologists presented almost perfect agreement (κ = 0.92, 95% CI 0.84-0.99) in determining whether patients are suspected of having inflammatory arthritis. There was also a 40% reduction in time-to-treatment decision for priority patients in the model including the ERP 15 . However, no study to date had assessed the ability of ERP in the management of other rheumatic diseases such as axSpA.…”

“…Studies that compared interobserver agreement between ERP and physicians for musculoskeletal disorders have mostly been conducted in orthopedic settings 8,14 . A recent study examined the ability of ERP in triaging patients with suspected inflammatory arthritis for priority assessment by a rheumatologist and the effect on access to care 15 . The results of the study are promising because ERP and rheumatologists presented almost perfect agreement (κ = 0.92, 95% CI 0.84-0.99) in determining whether patients are suspected of having inflammatory arthritis.…”

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

“…Nurses and allied health professionals, such as physiotherapists, dieticians and others, are key members of a true multidisciplinary musculoskeletal care team. Not surprisingly, the high cost and volume of people, who require improved access to musculoskeletal care in the primary care sector, has resulted in the emergence of the new inter-professional service models inclusive of health professionals with advanced scope of practice skills such as nurse practitioners and physiotherapists who have had advanced training in musculoskeletal healthcare [ 98 , 100 , [104] , [105] , [106] , [107] , [108] ]. As demand for musculoskeletal health services increase, MoCs will increasingly recommend alternate and innovative workforce models to ensure timely access to care and high-value service delivery.…”

Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial

“…Thus, patients with hand OA are currently not receiving the recommended intervention options and are increasingly referred to consultation by a rheumatologist in specialist care. At the same time there are often long waiting lists for new rheumatologist appointments, and their time should primarily be spent on patients with inflammatory rheumatic diseases, for whom early diagnosis, medical treatment and tight controls may induce disease remission [ 14 ]. New models for hand OA care are therefore needed, in which health professionals in extended roles may fulfil the important role as gatekeepers to facilitate rapid access to appropriate care and shorten wait times to rheumatologists [ 15 ].…”