Telerheumatology Shared-Care Model: Leveraging the Expertise of an ACPAC-Trained Extended Role Practitioner (ERP) in Rural-Remote Ontario

Amanda Steiman¹, Taucha Inrig², Katie Lundon³, Jocelyne Murdoch⁴ and Rachel Shupak⁵, ¹Sinai Health System, Toronto, ON, Canada, ²St. Michael's Hospital, Toronto, ON, Canada, ³University of Toronto, Toronto, ON, Canada, ⁴Arthritis Society, Toronto, ON, Canada, ⁵St. Michael's Hospital/University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2023

Keywords: Access to care, Health Services Research, Miscellaneous Rheumatic and Inflammatory Diseases

Session Information

Date: Monday, November 13, 2023

Title: (0993–1012) Health Services Research Poster II

Session Type: Poster Session B

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

Background/Purpose: A shortage of Rheumatologists has led to gaps in inflammatory arthritis (IA) care in Canada. Amplified in rural-remote communities, the number of Rheumatologists practicing rurally cannot be meaningfully increased. Alternate care strategies must be adopted. In this retrospective chart review, we describe the impact of a shared-care Telerheumatology model, utilizing a community-embedded Advanced Clinician Practitioner in Arthritis Care (ACPAC)-ERP and an urban-based academic Rheumatologist.

Methods: A Rheumatologist and an ACPAC-ERP established a monthly half-day Hub-and-Spoke-Telerheumatology clinic to care for patients with suspected IA, triaged by the ACPAC-ERP. Comprehensive initial assessments were conducted in-person by the ACPAC-ERP (Spoke);investigations were completed prior to the Telerheumatology visit. Retrospective analysis of demographics, time-to-key-care-indicies, patient-reported outcomes, clinical data, and estimated travel savings was performed.

Results: Data from 124 patients seen between January 2013-January 2022 were collected: 98% (n=496/504 visits) were virtual. Average age at first visit was 55.6 years, 75% were female. IA/Connective Tissue Disease (CTD) disease was confirmed in 80/124 (64.5%) patients. Mean time from primary care referral to ACPAC-ERP assessment was52.5 days and mean time from ACPAC-ERP assessment to the Telerheumatology visit was 64.5 days. An estimated 493,470 kilometers of patient-related travel was avoided.

Conclusion: A feasible, equitable, and effective ACPAC-ERP (Spoke) and Rheumatologist (Hub) Telerheumatology model of care assessing and managing patients with suspected IA in rural/remote Ontario was described. This model can be leveraged to increase capacity to deliver comprehensive virtual rheumatologic care in underserviced communities.

Table 1: Demographics and Clinical Characteristics of Cohort

Table 2: referral, Assessment and Follow-up visits
Some patients presented at first clinic visit alrady on DMARDS; of 21 who were eligible for new DMARD thrapy, treatment commenced on average in 52 days.

Figure 1: North East LHIN-based Study Population Accessing Health Services via Shared-Care Telerheumatology Model

Disclosures: A. Steiman: AstraZeneca, 1, GlaxoSmithKlein(GSK), 6, Pfizer, 5; T. Inrig: Pfizer, 12, I was hired by Unity Health as a Research Coordinator, my salary was supported by a Pfizer unrestricted investigator-initiated grant; K. Lundon: None; J. Murdoch: None; R. Shupak: None.

To cite this abstract in AMA style:

Steiman A, Inrig T, Lundon K, Murdoch J, Shupak R. Telerheumatology Shared-Care Model: Leveraging the Expertise of an ACPAC-Trained Extended Role Practitioner (ERP) in Rural-Remote Ontario [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/telerheumatology-shared-care-model-leveraging-the-expertise-of-an-acpac-trained-extended-role-practitioner-erp-in-rural-remote-ontario/. Accessed .

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