EULAR ‘Points to Consider’ for the Conduction of Workforce Requirement Studies in Rheumatology

Christian Dejaco^1,2, Polina Putrik³, Julia Unger⁴, Daniel Aletaha⁵, Gerolamo Bianchi⁶, Johannes W. J. Bijlsma⁷, Annelies Boonen⁸, Nada Cikes⁹, Axel Finckh¹⁰, Laure Gossec¹¹, Tore Kvien¹², Joao Madruga Dias¹³, Eric L. Matteson¹⁴, Francisca Sivera¹⁵, Tanja Stamm¹⁶, Zoltan Szekanecz¹⁷, Dieter Wiek¹⁸, Angela Zink¹⁹, Sofia Ramiro²⁰ and Frank Buttgereit²¹, ¹Rheumatology, Hospital of Bruneck, Bruneck, Italy, ²Rheumatology and Immunology, Medical University Graz, Graz, Austria, ³Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands, ⁴FH JOANNEUM, University of Applied Sciences, Bad Gleichenberg, Austria, ⁵Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria, Vienna, Austria, ⁶Rheumatology, ASL3-Azienda Sanitaria Genovese, Genua, Italy, ⁷Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands, ⁸Caphri Research Institute, Maastricht, Netherlands, ⁹University of Zagreb School of Medicine, Zagreb, Croatia, ¹⁰University Hospital of Geneva, Geneva, Switzerland, ¹¹Rheumatology, Sorbonne Université, Paris, France, ¹²Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ¹³Centro Hospitalar Médio Tejo, Torres Novas, Portugal, ¹⁴Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, ¹⁵Rheumatology, Hospital General Universitario de Elda. Comunidad Valenciana. Spain, Elda, Spain, ¹⁶Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Vienna, Austria, ¹⁷Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, Debrecen, Hungary, ¹⁸EULAR Standing Committee of PARE, Zurich, Switzerland, ¹⁹Epidemiology Unit / Rheumatology and Clinical Immunology, German Rheumatism Research Centre (DRFZ) / Charité University Hospital, Berlin, Germany, ²⁰Zuyderland Medical Center, Heerlen & Leiden University Medical Center, Leiden, Netherlands, ²¹Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: epidemiologic methods and rheumatic disease, Public Health Approach, Workforce

Session Information

Date: Monday, October 22, 2018

Title: Epidemiology and Public Health Poster II: Gout, Ankylosing Spondylitis, Osteoarthritis, Osteoporosis, Pain, and Function

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Recommendations and strategies have been developed for early referral, diagnosis and treatment of rheumatic diseases. These strategies, however, can only be implemented if sufficient manpower is available. An estimation of how many rheumatologists are needed to meet current and future population needs must be provided in order to counsel health care planners and decision makers. Current methods used for forecasting manpower are disparate, as are the variables incorporated into workforce projection models. Consequently, projections for the need of rheumatologists may vary by a factor of five between studies. The objective of these EULAR points to consider (PTC) was to guide future workforce studies in adult rheumatology in order to produce valid and reliable manpower estimates.

Methods: The EULAR Standardised Operating Procedures were followed. A multidisciplinary task force with experts including patients with rheumatic diseases from 11 EULAR countries and the USA was assembled. A systematic literature review (SLR) was conducted to retrieve workforce models in rheumatology and other medical fields. PTC were based on expert opinion informed by the SLR, followed by group discussions with consensus obtained through informal voting. The level of agreement with the PTC was voted anonymously.

Results: A total of 10 PTC were formulated (Table). The task force recommends models integrating supply (= workforce available to rheumatology), demand (= health services requested by the population) and need (= health services that are considered appropriate to serve the population). Projections of workforce requirement should consider all factors relevant for current and future workload in and outside direct patient care. Forecasts of workforce supply should consider demography and attrition of rheumatologists, as well as the effects of new developments in health care.

Conclusion: These EULAR endorsed PTC will provide guidance on the methodology and the parameters to be applied in future national and international workforce requirement studies in rheumatology.

Table 1. EULAR points to consider for the conduction of workforce requirement studies in rheumatology

No	Point to consider	LoA	LoE
1	Workforce models should integrate supply, demand and need of the respective geopolitical entity (e.g. municipality, region, state, country), and should express results as full time equivalents and as number of rheumatologists.	9.5 (0.9) 95%≥8	5
2	Workforce models should provide projections over a period of 5-15 years.	9.1 (1.1) 90%≥8	5
3	Workforce models should not assume a current balance between supply and need.	9.6 (0.7) 100%≥8	5
4	Workforce models should, where possible, rely on several data sources and include uncertainty analyses.	9.8 (0.4) 100%≥8	5
5	Workforce models should be regularly updated; updates should include an analysis of the actual performance (i.e. prediction validity) of the previous model.	9.5 (0.6) 100%≥8	5
6	Workforce need for patient care should be based on the prevalence and referral rates of diseases managed by rheumatologists as well as on an estimation of time needed per patient.	9.7 (0.7) 100%≥8	5
7	Workforce need for patient care should consider current and future demographics, sociocultural characteristics of the population and disease patterns.	9.5 (0.9) 95%≥8	5
8	Workforce need and supply should consider work outside rheumatology patient care (e.g. administrative tasks, research, teaching, non-rheumatologic disease management), as well as patient care performed by other health professionals in rheumatology.	9.4 (0.9) 95%≥8	5
9	Workforce supply should account for demographic composition of rheumatologists, the number of rheumatologists entering and leaving the workforce, and generational attitudes of rheumatologists towards scope of practice and work-life balance.	9.1 (2.3) 85%≥8	5
10	Workforce models should consider the effects of medical developments, including new technologies, medications, artificial intelligence and e-health, on demand and supply.	9.4 (1.1) 85%≥8	5

Numbers in column ‘LoA’ indicate the mean and SD (in parentheses) of the LoA, as well as the percentage of task force members with an agreement ≥8. None of the studies identified corresponded to any of the categories of Oxford Centre for Evidence-Based Medicine (OCEBM). Evidence level was therefore set as “5”, which is the lowest level of evidence. LoA, Level of Agreement; LoE, Level of Evidence according to OCEBM 2011 levels of evidence.

Disclosure: C. Dejaco, None; P. Putrik, None; J. Unger, None; D. Aletaha, None; G. Bianchi, None; J. W. J. Bijlsma, None; A. Boonen, None; N. Cikes, None; A. Finckh, None; L. Gossec, None; T. Kvien, None; J. Madruga Dias, None; E. L. Matteson, None; F. Sivera, None; T. Stamm, None; Z. Szekanecz, None; D. Wiek, None; A. Zink, None; S. Ramiro, None; F. Buttgereit, None.

To cite this abstract in AMA style:

Dejaco C, Putrik P, Unger J, Aletaha D, Bianchi G, Bijlsma JWJ, Boonen A, Cikes N, Finckh A, Gossec L, Kvien T, Madruga Dias J, Matteson EL, Sivera F, Stamm T, Szekanecz Z, Wiek D, Zink A, Ramiro S, Buttgereit F. EULAR ‘Points to Consider’ for the Conduction of Workforce Requirement Studies in Rheumatology [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/eular-points-to-consider-for-the-conduction-of-workforce-requirement-studies-in-rheumatology/. Accessed .

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