Session Information
Session Type: Abstract Submissions (ARHP)
Background/Purpose
An experienced Advanced Clinician Practitioner in Arthritis Care (ACPAC) trained physiotherapist with advanced directives using a standardized Electronic Medical Record (EMR) triage tool conducted a 15 minute assessment on patients with suspected inflammatory arthritis. We evaluated the time from referral to the initiation of Disease Modifying Antirheumatic Drug (DMARD) therapy in those patients who had been triaged and confirmed to have inflammatory arthritis (IA).
Methods
Patients were referred by local primary care physicians to a solo community rheumatology practice. The rheumatologist triaged the paper referrals, and those with suspected inflammatory arthritis were selected to be initially seen by the ACPAC physiotherapist (ACPAC triage model). Patients in whom the physiotherapist suspected inflammatory arthritis were given a workup with laboratory and x-ray testing as per advanced directives. These patients were then booked as priority to see the rheumatologist. The average number of days from referral to the initiation of DMARDs was determined for those patients confirmed to have a diagnosis of IA. A retrospective chart review using the rheumatologists EMR was conducted on new referrals that were seen solely by the rheumatologist (Traditional triage model) and suspected to have IA. The time from referral to the initiation of DMARDs was determined was also determined for this group.
Results
One hundred and twenty-one patients were triaged by the ACPAC physiotherapist prior to the assessment by the rheumatologist. Forty eight patients (40%) were diagnosed with IA and 31 patients were started on a DMARD. Twenty-nine patients (93.5%) were started on a DMARD at the first Rheumatology visit, and two patients (6.5%) were started on a DMARD on the second Rheumatology visit. The average number of days from referral to Rheumatology visit for patients with IA was 73 days. The average number of days from the referral to initiation of DMARDs was 75 days. We compared these findings to patients from a retrospective chart review using the Traditional Triage Model. One hundred and ten charts were retrospectively reviewed on patients with suspected IA. There were 53 patients (48%) diagnosed with IA and forty-three patients were started on a DMARD. Fifteen patients (35%) started on a DMARD at the first Rheumatology visit, and 28 patients (65%) started on a DMARD at the second Rheumatology visit. In this group, the average number of days from referral to Rheumatology visit was 84 days. The average number of days from the referral to the initiation of DMARDs was 125 days.
Conclusion
The utilization of an ACPAC trained physiotherapist with advanced directives to triage suspected inflammatory arthritis referrals prior to a Rheumatology assessment resulted in an earlier initiation of DMARDs with the majority of patients starting a DMARD at the first Rheumatology visit. This approach may serve as a model for other settings in which there is a need for health human resources in musculoskeletal care.
Disclosure:
V. Ahluwalia,
None;
T. Larsen,
None.
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