Rheumatology workforce issues in South Asia: Challenges and solutions

Aggarwal, Amita; Haq, Syed Atiqul

doi:10.1111/1756-185x.13793

Cited by 9 publications

(3 citation statements)

References 26 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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“…The demand for rheumatology care is consistently exceeding the workforce worldwide, which is negatively impacting the care of patients with rheumatic and musculoskeletal diseases (RMDs) [1][2][3][4][5][6][7]., This global imbalance is expected to increase in the upcoming years. For instance, the 2015 American College of Rheumatology (ACR) Workforce Study projected that by 2030, the number of adult rheumatology providers would decline by 25%, resulting in demand exceeding the supply by 102% in the USA [1].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, the 2015 American College of Rheumatology (ACR) Workforce Study projected that by 2030, the number of adult rheumatology providers would decline by 25%, resulting in demand exceeding the supply by 102% in the USA [1]. This disproportion between the offer and the demand is also reported from other regions of the world, regardless of their economic levels, such as Europe [4,6], Latin America [2], and South Asia [7]. This is even more pronounced in the eld of pediatric rheumatology [1].…”

Section: Introductionmentioning

confidence: 99%

The ArLAR Rheumatology Workforce: Current Status, Challenges, Opportunities, and Future Needs

Ziadé

Hmamouchi

Haouichat

et al. 2023

Preprint

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Objective The Arab League of Associations for Rheumatology (ArLAR) Research Group (ARCH) conducted this study to investigate the number of current practicing rheumatologists in the Arab countries, to estimate the number of rheumatologists in 10 years, and to evaluate the current workload, practice profile, consultation waiting time and geographical mobilities of these rheumatologists. Methods This cross-sectional survey study was conducted in 16 Arab countries in two parts. The first survey was addressed to national societies to estimate the current and projected workforce. The second was an anonymous e-survey elaborated by the study steering committee on the Google Forms platform and distributed to Arab rheumatologists using social media, WhatsApp, and mass e-mails to evaluate their practice. Results The mean number of rheumatologists in Arab countries was 0.84 per 100,000 inhabitants (mean age 47.5 years, 55% females), ranging from 0.06 in Sudan to 1.86 in Tunisia. The number of rheumatologists is expected to increase by 50% in 2032. Nevertheless, a 20% increase in population associated with an increase in demand is also expected. Data from 446 rheumatologists (mean age 43.9 years, 60.5% females) revealed that 72% worked full-time, and 53% were employed in the public sector only. The average waiting time for a rheumatology consultation was 19.9 days. Of 394 rheumatologists, 19% obtained their rheumatology diplomas from non-Arab countries, and 47% of Gulf rheumatologists were non-citizen physicians. Conclusion Considering local demographic disparities, healthcare system differences, and geographical mobilities, national authorities are advised to implement effective intervention plans to optimize the rheumatology workforce.

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