Optimal care for rheumatoid arthritis: a focus group study

Abstract

Our study sought to identify barriers to optimal care for individuals with rheumatoid arthritis (RA). Our study was set in a population with universal access to comprehensive health care in the context of a university hospital health network. Using purposive sampling, we invited RA patients, health professionals, and decision makers from urban and rural regions to participate in structured focus group interviews. Content analysis was performed to determine themes emerging from the data. We identified four general themes. First, initial barriers to optimal care for people begin before primary care contact, at the level of the general population and/or related to primary care access. Second, many factors (at the patient, physician, and system level) influenced how quickly a patient is referred from primary to specialty care. Third, after referral, multiple comanagement issues influence patient outcomes. Fourth, optimizing RA care requires adequate resources. Participants emphasized the need for more education (of patients, of health care providers, and within the general community), better communication between and among patients and health care providers, and more efficient use of existing resources. Our work provides insights regarding barriers to and facilitators of optimal care in RA. Further work with these stakeholder groups in our health care region will examine potential solutions and the feasibility of their implementation. Our work provides an example of how research can assist stakeholder leaders in creating structured and incremental plans to improve health care delivery for persons with chronic diseases like RA.

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

“…This is particularly the case for patients with vague and mild symptoms. The main factors influencing timely referral for early RA are clinical patient characteristics, patient preferences, access issues such as lack of timely appointments and availability of rheumatology services and GPs' confidence and expectations regarding the collaboration with the rheumatologist (17,28). The long waiting times for appointments and the limited availability of rheumatologists should be addressed to reduce treatment delay.…”

Wait Times for Physical and Occupational Therapy in the Public System for People with Arthritis in Quebec

“…Therapists noted that access to publicly available programmes was very limited, 19 which forced patients to either pay for private services or go without. This underscores the effect of socio-economic status on access to PT and OT.…”

“…In fact, the therapists believed that in many cases physicians do not even initiate a referral because they are well aware that the patient will be unable to access a therapist. 19 People with higher levels of education are also more likely to perceive the need for therapy services, [20][21][22][23][24] which may indicate increased knowledge about potential benefits.…”

“…Further, the availability of publicly ensured PT and OT services (in this case, those covered by the provincial universal health insurance board, the Régie de l'assurance maladie du Québec or RAMQ) has decreased in Canada over the past two decades, presenting barriers to access especially for those who do not have supplementary health insurance. 19 The main goals of our study were to document wait times from referral by physician to consultation in PT or OT in the public system for people with arthritis and to explore whether these wait times differed depending on diagnosis (RA vs. OA), service provider (hospital vs. community health centre vs. rehabilitation centre), and geographic area (cities with a school of rehabilitation vs. the rest of the province). We also described any methods of prioritization used in providing appointments.…”

Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data

“…In Canada, both rheumatologists and primary care physicians identify long wait times as a barrier to providing adequate care, [37][38][39] and waits to see rheumatologists are longer than for most other medical subspecialties. 40 Our findings underline the need to increase awareness among patients, physicians and policy-makers of the major burden that rheumatic diseases places on patients, society and health care systems, and to prioritize planning of health care services, medical education 41,42 and research.…”