Session Title: Healthcare Disparities in Rheumatology - Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: A rheumatology specialty clinic embedded in a primary health care clinic on a First Nations reserve was established six years ago to improve access to care and reduce arthritis outcome inequities. Although the clinic has proved successful to achieve inflammatory arthritis physician-derived disease control targets during a 24-month follow-up period, patient-reported pain, disease severity and physical function did not significantly improve. The objective of this study was to explore remaining care needs from patient and provider perspectives, to inform enhancements to the model of care in this clinic.
Methods: A qualitative study with patients and their family members (n=10), health providers (n=14) and administrative staff (n=10) was performed. Thirty-four in-depth interviews were conducted to reach thematic saturation. Interviewing was assisted by semi-structured guides to focus on personal narratives and perceptions of needs and solutions. Interviews were audio recorded, transcribed verbatim and coded to find meaningful concepts. Concepts were then grouped into themes, which were validated using a member-checking strategy. An inductive interpretation was then conducted using “health service quality” and “cultural competency” theoretical frameworks.
Results: Four main themes of improvement areas were identified (see Table). The first three themes were related to the concept of health service quality: service organization, communication between patients and providers, and holistic patient support mechanisms integrating mainstream and traditional knowledge. Participants stressed that in order to realize treatment goals and thereby reduce health disparities, it was important to improve the administrative and inter-personal quality of existing services. Suggested strategies included administrative and organizational accommodations, health-interpreter services, cultural training and cultural immersion for providers, coordination with traditional healers, use of community health workers, culturally competent health promotion activities and involvement of family and other community members in the management of arthritis. The last theme identified was the need to enhance service availability and expand the scope of provided services beyond the health clinic, such as exercise programs and support groups.
Conclusion: Enhancements to an existing model of care needed to better meet the needs of the community, which could reduce arthritis outcome disparities in an outreach specialty clinic, were identified. Improved service organization, communication strategies, holistic patient support mechanisms and an expansion of services outside of the health clinic were suggested.
|Enhancement Required||Illustrative Participant Quote|
|Service organization||“There’s a fragmentation and disintegration of health services on reserve.” (Male, clinical services)|
|Communication between providers, patients and their families||“That (a) client agrees with you…that does not mean you know that person, you have to learn how to think Indian, think like an Indian to know that person…(we need someone)to speak for you if (you) do not understand…” (Female, RA patient)|
|Support for patients to adequately manage their disease in a holistic manner, integrating mainstream and traditional knowledge||“I need to understand more…I need to meet other people who are living this…mentally, I am traditional, I got to sweat, I leave things on creators hands… I am trying to figure out how to help her…It is a chronic disease…it is not going to get better…I want to prepare to help her anyway I can” (Male, husband of a woman with RA)|
|Expansion of services outside of the health clinic||“They do not have support groups out here for smoking, dieting, they do exercising but…even arthritis support groups that would be easier to associate with other people with arthritis cause they know exactly what are you going through…becoming more acceptable in the society to have arthritis…I think exercises for peoples needs… there are certain exercises that we can do and we cant do.” (Female, client)|
To cite this abstract in AMA style:Loyola-Sánchez A, Crowshoe L, White T, Lacaille D, Barnabe C. “There Are Still a Lot of Things That I Need”: A Qualitative Study Exploring Opportunities to Improve the Health Outcomes of First Nations People with Arthritis Seen at an on-Reserve Outreach Rheumatology Clinic [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/there-are-still-a-lot-of-things-that-i-need-a-qualitative-study-exploring-opportunities-to-improve-the-health-outcomes-of-first-nations-people-with-arthritis-seen-at-an-on-reserve-o/. Accessed December 17, 2018.
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