The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis

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ObjectiveTo understand how the expansion of rheumatology supply and the introduction of multidisciplinary care was associated with access to rheumatology services.MethodWe accessed Population Data BC, a longitudinal database with de‐identified individual‐level health data on all residents of British Columbia (BC), Canada, to analyse physician visits and prescribing from 2010/11 to 2019/20. We calculated access as the time from referral to first rheumatologist visit, and for people with rheumatoid arthritis (RA), time to first disease‐modifying anti‐rheumatic drug (DMARD). Associations between lag time, patient characteristics and system variables were explored using quantile regression.ResultsOver the study period, there were 149,902 new rheumatologist visits, with 31% more visits in 2019/20 than in 2010/11. The proportion of first‐visits for inflammatory arthritis (IA) patients increased from 28% to 51%. The median time from referral to first visit decreased by 22 days (35%) from 63 days (IQR 21‐120) in 2010/11. For people with RA, time from referral to DMARD decreased by 4 days (6%) to 62 days. Male sex, living in metropolitan areas, and having a rheumatologist who used a multidisciplinary care assessment code were associated with shorter times from referral to first DMARD.ConclusionAccess to rheumatology care improved and the increased proportion of IA patients in the first‐visits case‐mix indicates that rheumatologist supply and incentives for multidisciplinary care may have improved referral patterns. However, time to DMARDs for people with RA remained long, and we found signals of unequal access for females and people living outside of metropolitan areas.

Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

The Association of Rheumatologist Supply and Multidisciplinary Care With Timely Patient Access to Rheumatologists: Evidence From British Columbia, Canada

Biln,

Guh,

Bansback

et al. 2024

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“…Our results suggest that the introduction of the MCA code did not change the number of unique patients seen by rheumatologists; however, we observed a reduction in the number of days between visits for patients with RA whose rheumatologists used the MCA code. Past research found that the introduction of the code was associated with increased numbers of patients seen 2,6 and services provided. 6 Beyond access, evidence suggests that the MCA may change the nature of clinical care.…”

Section: Discussionmentioning

confidence: 99%

“…2 This includes increasing the overall volume of patients seen, the number of services provided by rheumatologists, and reducing wait times for new patients. 2,[4][5][6] One remaining question regarding the MCA code is its impact on health system costs. More than 70% of BC rheumatologists now use the MCA code, billing it 30,000 times in 2022 at a total cost of $6.5 million.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Billing Code to Reimburse Nurse‐Supported Rheumatology Care on Health Care Costs and Access: An Interrupted Time Series Analysis

Trenaman,

Guh,

Law

et al. 2024

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ObjectiveThis study was undertaken to evaluate the impact of a Multidisciplinary Care Assessment (MCA) billing code on health system costs and access to care in British Columbia (BC).MethodsData on all people treated by rheumatologists in BC were obtained from five linked health administrative databases held by Population Data BC from April 1, 2006, to March 31, 2020. Rheumatologists were allocated to either the intervention (ever‐billers) or control group (never‐billers). For the intervention group, the index date was the month of first MCA code billing. For the control group the index data was imputed from intervention index dates. Our analysis focused on a 48‐month period (24 months pre‐ and post‐index date). We evaluated the impact on two cost (rheumatoid arthritis (RA)‐related costs; total health care costs) and access outcomes (rheumatology‐related visits per rheumatologist; days between rheumatology visits for RA‐patients) using an interrupted time‐series analysis.Results46 rheumatologists (31 intervention, 15 control) met our inclusion criteria. Introduction of the MCA was associated with a small but significant increase in RA‐related costs which, at two years, translates to a net absolute change of $9.66 per‐patient‐per‐month, but no statistically significant changes in total health care costs. There was no statistically significant change in the number of rheumatology‐related visits, but at two years there was a net absolute reduction in median days between rheumatologist visits for RA‐patients (6.3 days).ConclusionThe introduction of the MCA code was associated with a negligible increase in the RA‐related costs and an improvement in access to ongoing care for patients.

“…Rheumatology is mainly an outpatient specialty, with patients' clinical visits often comprising a major aspect of care (1). Timely initiation and sustained maintenance of medical interventions, which typically occur at clinical visits, are associated with improved prognosis and symptomatic amelioration in many rheumatic diseases (2). However, the appropriate frequency to visit a physician for rheumatic disease follow-up has not been a major focus of study (3), resulting in a lack of guidance for rheumatic disease follow-up for common conditions like rheumatoid arthritis (RA) (4) and osteoarthritis (OA) (5).…”

Section: Introductionmentioning

confidence: 99%

Clinical Visit Frequencies in Rheumatology: A Systematic Literature Review

Jiang

Rudin

Solomon

2023

ObjectiveClinical visits are a fundamental aspect of rheumatic disease care, but recommendations for appropriate visit frequencies are largely absent from guidelines, scarcely studied, and inconsistently reported. The aim of this systematic review was to summarize the evidence pertaining to visit frequencies for major rheumatic diseases.MethodsThis systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Title/abstract screening, full‐text screening, and extraction were carried out by 2 independent authors. Annual visit frequencies were either extracted or calculated and stratified by disease type and country of study. Weighted mean annual visit frequencies were calculated.ResultsA total of 273 relevant manuscript records were screened, and 28 were included after applying selection criteria. The included studies were equally divided between US and non‐US and were published between 1985 and 2021. Most (n = 16) focused on rheumatoid arthritis (RA), systemic lupus erythematosus (SLE; n = 5), and fibromyalgia (FM; n = 4). For RA, the average annual visit frequencies were 5.25 for US rheumatologists, 4.80 for US non‐rheumatologists, 3.29 for non‐US rheumatologists, and 2.74 for non‐US non‐rheumatologists. For SLE, annual visit frequencies for non‐rheumatologists were much higher than for US rheumatologists (12.3 versus 3.24). For FM, annual visit frequencies were 1.80 for US rheumatologists and 0.40 for non‐US rheumatologists. There was a decreasing trend of visit frequency to rheumatologists from 1982 to 2019.ConclusionEvidence for rheumatology clinical visits was limited and heterogeneous on a global scale. However, general trends suggest more frequent visits in the US and less frequent visits in recent years.