https://orcid.org/0000-0002-6862-7796
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ABSTRACT
Early referral to rheumatology of people with suspected inflammatory arthritis is associated with better outcomes. Typically, these individuals are seen by a family physician who would assess the need for rheumatology referral. However, some may first consult a physical therapist where no physician referral is required. New interprofessional referral pathways, such as direct referral from a physical therapist to a rheumatologist, could enhance early access to a rheumatologist. Our objective was to explore perceptions of clinicians and people with inflammatory arthritis regarding physical therapists referring directly to rheumatologists. We used purposive and snowball sampling to recruit participants for five focus groups: rheumatologists, family physicians, physical therapists, people with inflammatory arthritis, and a mixed group of physical therapists and people with inflammatory arthritis. Thematic analysis revealed four core themes: difficulties accessing care, reluctance of family physicians and rheumatologists toward the new pathway, interprofessional relationships (or lack thereof), and opportunities along the referral pathway. The conclusions are that care must be optimized by ensuring swift referral for those who require it; and that there is a need for knowledge translation to all actors on the advantages of this new pathway.
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No potential conflict of interest was reported by the author(s).
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Notes on contributors
Tatiana Orozco
Tatiana Orozco finished her professional masters in physiotherapy in 2017 at the Université de Montréal. She now works as a research agent and as a pediatric physiotherapist. Tatiana is interested in the fields of rheumatology, musculo-skeletal physiotherapy and patient access.
Debbie Ehrmann Feldman
Debbie Feldman is Professor, School of Rehabilitation, Faculty of Medicine and has a secondary affiliation at the School of Public Health, department of social and preventive medicine at Université de Montréal. She conducts health services research in musculoskeletal disease and arthritis, investigating access to care in rehabilitation and optimal ways of prioritizing care for patients with chronic musculoskeletal problems and arthritis.
Sasha Bernatsky
Sasha Bernatsky, MD PhD is a rheumatologist, a James McGill professor and a senior scientist in the Centre for Health Outcomes Research and Division of Clinical Epidemiology at the Research Institute of the McGill University Health Centre. She is an established leader in research and knowledge translation, with almost 400 peer-reviewed articles, and numerous awards. Of note Dr. Bernatsky helped create the Canadian Network for Advanced Interdisciplinary Methods (canaim.ca) team, funded by the Drug Safety and Effectiveness Network to provide new, accurate data on the long-term, real-world outcomes of drug therapies, including a large national registry of patients receiving biosimilar agents and their legacy drugs.
Jean Légaré
Jean Légaré has been member of many committees and organizations including l’Association des arthritiques de Québec, the Arthritis Alliance of Canada, Canadian Arthritis Patient Alliance and the Steering Committee of the Research Fund for Arthritis and Rheumatic Diseases at Université Laval, the Advisory Board of Cochrane Canada, ARC Canada’s Patients Intéressés par la Recherche sur l’Arthrite (PIRA) and many others. Jean has facilitated several Patients' Forums, which seek to better disseminate information about the disease and recent developments in research for relief.
Kadija Perreault
Kadija Perreault PhD is a physiotherapist and Associate Professor in the Department of Rehabilitation, Faculty of Medicine, at Université Laval. She is a researcher at the Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris). Her work focuses on access and organization of services in rehabilitation and primary care, interprofessional collaboration, as well as on the evaluation of professional practices and interventions for persons experiencing pain.
Andrews Kwabena Tawiah
Andrews Tawiah holds a Ph.D. in Rehabilitation Science from the University of Alberta. His research focuses on developing new models of care including advanced practice physiotherapy. He has expertise in both quantitative and qualitative research methodologies. His research aims to improve patient outcomes, improve patient experience of care and reduce the cost of care delivery.
Michel Zummer
Michel Zummerg, is Associate Professor (professeur agrégé) at the Université de Montréal and served as Chief of Rheumatology at Maisonneuve-Rosemont Hospital from 1997-2017 where he practices as a clinical rheumatologist. Currently, Dr. Zummer’s focus is improving health care delivery for individuals with rheumatological problems. In addition, his research interests include Psoriatic Arthritis, Spondyloarthritis and Rheumatoid Arthritis.
Anne Hudon
Anne Hudon is an assistant professor at the School of Rehabilitation at Université de Montréal. Ethical aspects of practice are a key theme in her research, including professional ethics and equity in care. Her research interests include health policy analysis (organization of care, roles of professionals), rehabilitation after a work injury and improving rehabilitation services for people living with physical disabilities and persistent pain.