https://orcid.org/0000-0002-8055-6062
Abstract
Purpose
The objective of this qualitative study was to explore patient, rheumatologist, and extended role practitioner (ERP) perspectives on the integration of an allied health rheumatology triage (AHRT) intervention in Ontario rheumatology clinics. Triage is the process of identifying the urgency of a patient’s condition to ensure they receive specialist care within an appropriate length of time. This research explores the clinical/logistical impact of triage by occupational and physical therapists with advanced arthritis training (ERPs), including facilitators and barriers of success, and recommendations for future application.
Participants and Methods
Semi-structured telephone interviews were held with participating rheumatologists, ERPs, and a sample of patients from each clinical site (4 community, 3 hospital) in five Ontario cities. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using basic qualitative description. Two independent researchers compared coding and achieved consensus.
Results
Patients (n=10), rheumatologists (n=6), and ERPs (n=5) participated in the study and reported reduced wait-times to rheumatology care, diagnosis, and treatment for those with inflammatory arthritis (IA). Rheumatologists and ERPs perceived that the intervention improved clinical efficiency and quality of care. Patients reported high satisfaction with ERP assessments, valuing early joint examination/laboratory tests, urgent referral if needed, and the provision of information, support, and management strategies. Facilitators of success included: supportive clinical staff, regular communication and collaboration between rheumatologist and ERP, and sufficient clinical space. Recommendations included extending ERP roles to include stable patient follow-up, and ERP care between scheduled rheumatology appointments.
Conclusion
Findings support the integration of ERPs in a triage role in the community and hospital-based rheumatology models of care. Future research is needed to explore the impact of utilizing ERPs for stable patient follow-up in rheumatology settings.
Acknowledgments
We would like to extend our thanks to the three partner organizations in this project: the Ontario Best Practices Research Initiative including administrative support from Angela Cesta; the Ontario Rheumatology Association including administrative support and coordination from Sandra Couto; and the Arthritis Society (Ed Ziesmann and Joanne Simons). We would also like to thank our qualitative interviewer, Paula Veinot, participating Arthritis Society ERPs (Anne MacLeod, Danielle McCormack, Lynn Richards, Mercedes Reeb, Sue MacQueen), rheumatologists (Drs. Andrew Chow, Angela Montgomery, Art Karasik, Irene Vasiliu, Marie Clements-Baker, Mary Bell, Sanjay Dixit), and patients for their participation in this study. We appreciate the input and guidance from our advisory committee members: Cathy Hofstetter (consumer) and Tiffany Larsen and Angelo Papachristos (ACPAC physical therapists). Financial support for this work was received from the Arthritis Society; the Ontario Rheumatology Association, and the Ontario Best Practices Research Initiative. The study investigators are representatives of these organizations and were involved in all aspects of the study design, implementation and interpretation of the results.
Disclosure
The authors report no conflicts of interest in this work.