An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

Abstract

Objective

To facilitate access and improve wait times to a rheumatologist’s consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision.

Materials and methods

A community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model.

Results

One hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7, range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).

Conclusion

A well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

Keywords:

• rheumatology
• health services accessibility
• interprofessional relations
• community health services
• integrated delivery systems

Acknowledgments

The authors would like to acknowledge the assistance of Monish Ahluwalia. Financial support was received from the Bristol Myers Squibb Unrestricted Educational Grant. The abstract of this paper was presented at the 69th Annual Meeting of the Canadian Rheumatology Association (2014) as a poster presentation with interim findings. The poster’s abstract was published under “Poster Presentations” in The Journal of Rheumatology 2014; 41:7 doi:10.3899/jrheum.140420. Additionally, the abstract of this paper was presented at the 2014 American College of Rheumatology Meeting as a poster presentation with interim findings. The poster’s abstract was published under “ACR/ARHP Abstract Supplement” in Arthritis and Rheumatology 2014, 66:10 (supplement): https://doi.org/10.1002/art.38914.

Disclosure

The authors report no conflicts of interest in this work.