ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1931

Models Of Care For Arthritis: Drivers, Facilitators and Barriers To Their Development and Implementation

Aileen M. Davis1, Cheryl Cott2, Rose Wong3, Michel Landry4, Linda Li5, Allyson Jones6, Cy Frank7, Sydney C. Lineker8, Louise Bergeron9, Gillian A. Hawker10, Dianne P. Mosher11, Vandana Ahluwalia12, Michel Zummer13, Susan B. Jaglal14, Rhona McGlasson15, Richard Birtwhistle16, Sherry Bar17 and Elizabeth M. Badley18, 1Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Ontario, ON, Canada, 2Divison of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada, 3Division of Health Care & Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada, 4Department of Community and Family Medicine, Physical Therapy Division, Duke University Medical Center, Durham, NC, 5Arthritis Centre of Canada and Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada, 6Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada, 7Alberta Bone and Joint Institute and Department of Surgery, University of Calgary, Calgary, AB, Canada, 8The Arthritis Society, Toronto, ON, Canada, 9Canadian Arthritis Patient Alliance, Ottawa, ON, Canada, 10Women's College Research Institute, University of Toronto, Toronto, ON, Canada, 11Med, University of Calgary, Calgary, AB, Canada, 12Past President, Ontario Rheumatology Association, Brampton, ON, Canada, 13Rheumatology, Ch Maisonneuve-Rosemont, Montreal, QC, Canada, 14Department of Physical Therapy, Department of Physical Therapy, University of Toronto, Toronto, ON, Canada, 15Bone and Joint Canada, Toronto, ON, Canada, 16Centre for Studies in Primary Care and Family Medicine and Community Health and Epidemiology, Queen's University, Kingston, ON, Canada, 17British Columbia Ministry of Health Services, Victoria, BC, Canada, 18Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Health Services Research, Quality Measures and Quality of Care - Innovations in Health Care Delivery

Session Type: Abstract Submissions (ACR)

Background/Purpose: Management of arthritis is a growing concern given disease prevalence and limited health care resources. In the context of a larger project investigating innovative models of care (MOC) delivery for people with arthritis, this study sought to identify the drivers, facilitators and barriers to the MOC development and implementation in British Columbia (BC), Alberta (AB) and Ontario (ON), Canada.

Methods: This study used embedded case methodology, with triangulation of documents from peer-reviewed literature, reports, working papers of MOC, health human resources (HHR), etc.; population/administrative data regarding utilization of care; and, semi-structured, one-on-one stakeholder interviews with health planners, decision-makers, program managers, and care providers. Thematic analysis using a constant comparative approach was used to identify drivers, facilitators and barriers to models/innovative processes of providing care.

Results: 79 key informants interviews (BC=24, AB=22, ON=33) of which 28 (BC=9, AB=10, ON=9) were in-depth interviews related to drivers, facilitators, and barriers were conducted between 2009 and 2012. In addition to traditional primary care to specialist referral, MOC identified included community-based direct access to services, multi-disciplinary and inter-disciplinary care. Various processes were implemented to enhance access and care provision: therapists with skills in arthritis assessment and management were embedded in primary care; specialty multi-disciplinary musculoskeletal clinics were established to interface with primary care; therapists with advanced arthritis skills practiced in triage roles to expedite priority referrals for the rheumatologist; and, health professionals traveled to smaller communities to provide service and/or utilized telehealth. For both inflammatory (IA) and non-IA, MOC developed were driven and facilitated by local factors including a local champion and the willingness of local providers to work together. In BC, this was further influenced by centralized control of resources. In AB, provincial chronic disease management policy and resources facilitated care for people with non-IA, although the resources were not viewed as sufficient to meet need. For IA services, barriers included challenges with primary care identification of need for and access to a rheumatologist; limited HHR and skill sets, particularly in rural/remote communities (this also posed challenges in providing multi-disciplinary care); and, geographically dispersed and small populations. For non-IA services, lack of recognition as a priority in local, regional, and provincial jurisdictions and limited community resources and chronic disease management resources also were barriers.  

Conclusion: MOC varied greatly and local factors drove care provision for people with arthritis. Policies that facilitate arthritis management as a priority at local, regional and provincial levels, greater collaboration and linkages with community resources and increased health providers with the necessary skill sets are required to address current barriers to care for people with arthritis.

Disclosure:

A. M. Davis,
None;

C. Cott,
None;

R. Wong,
None;

M. Landry,
None;

L. Li,
None;

A. Jones,
None;

C. Frank,
None;

S. C. Lineker,
None;

L. Bergeron,
None;

G. A. Hawker,
None;

D. P. Mosher,
None;

V. Ahluwalia,
None;

M. Zummer,
None;

S. B. Jaglal,
None;

R. McGlasson,
None;

R. Birtwhistle,
None;

S. Bar,
None;

E. M. Badley,
None.

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