Background/Purpose: Early referral to rheumatology of persons with suspected inflammatory arthritis is associated with better outcomes. Typically, patients are first seen by a family physician who assesses the need for referral to a rheumatologist. However, many people who do not have a regular family physician may consult a physical therapist where no physician referral is required. Enabling direct referral from a physical therapist to a rheumatologist could enhance early access to a rheumatologist; recent evidence indicates that physical therapists can appropriately identify patients with inflammatory arthritis. Our objective was to explore perceptions of professionals and patients regarding enabling physical therapists to refer patients with inflammatory arthritis directly to rheumatologists.

Methods: We conducted 5 focus groups with a total of 29 participants. There were 4 homogeneous groups with: 1) 5 rheumatologists, 2) 7 family physicians, 3) 6 physical therapists and 4) 6 patients. The fifth group was mixed and included 3 physical therapists and 2 patients. We used purposive and snowball sampling to recruit participants. All 8 patients with inflammatory arthritis were recruited via the Canadian Arthritis Society. Meetings were audio-taped and transcripts were analyzed using thematic analysis.

Results: Two common core themes were identified from all focus groups: 1) difficulties accessing care, and 2) interprofessional relationships. The first theme included aspects such as waiting times to consult rheumatologists and physical therapists in the public sector, as well as financial barriers related to consulting physical therapists in the private sector. The second theme included perceptions of physical therapists’ roles and abilities, appropriateness of referrals, multidisciplinary vs. solo practitioners, communication pathways and traditionalist vs. contemporary style of practice by family physicians. Besides these two main themes, several groups discussed other issues. The health care groups (rheumatologists, family physicians and physical therapists) talked about  lack of awareness of the new agreement that physical therapists can directly refer to rheumatologists. In the physician groups, 2 other issues were discussed:  professional responsibilities (e.g. scope of practice, gatekeeping and coordination of care) and the consult fee for rheumatologists. In the physical therapist focus group, self-confidence in identifying inflammatory vs. non-inflammatory conditions was also raised.

Conclusion: Regarding difficulties accessing care, waiting time to see a rheumatologist remains the biggest barrier for patients with new-onset inflammatory arthritis followed by the lack of access to physical therapists and family physicians. Further developing the relationship among the health professionals involved with these patients could optimize patient care. This could be done through education about everyone’s role, building efficient communication pathways and creating opportunities for interprofessional connections. In addition, professional regulatory bodies should increase awareness about the new agreement regarding direct referral by physical therapists to rheumatologists.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-care-for-patients-with-inflammatory-arthritis-by-enabling-physical-therapists-to-directly-refer-to-rheumatologists-a-qualitative-study/