In 2009, ILAR (International League of Associations for Rheumatology) funded a project in Macedonia supporting establishment of national Rheumatoid Arthritis (RA) registry. An academic partnership between the rheumatology clinics at the University of Michigan and the University of Skopje was established allowing exchanges of rheumatologists, trainees and medical students.
Results from this project pointed to unmet needs in patient access to qualified care and suboptimal therapy, among others. For RA patients, the average DAS-28 score was 5.2. All rheumatologists in Macedonia practice in the capital, with half of the population or over one million people without good access to rheumatologic care. Training additional rheumatologists from underserved regions and patient education were some of goals identified for improving access and quality of care for patients with rheumatic conditions.
In 2011, ILAR funded a second project in Macedonia, supporting rheumatologic education for physicians from underserved regions and patient education. In a collaborative effort between the rheumatology clinics at the University of Michigan and the University in Skopje, an internist from the city of Bitola commenced training in rheumatology. A local rheumatology clinic has been established within the regional hospital, providing access and care for a region of 300,000 people. The candidate physician has been accepted for formal training at the rheumatology clinic in Skopje, pending approval from the ministry of health. A longitudinal data collection will address the impact of local care on patients with RA.
Parallel to this effort, we launched an educational program for patients in partnership with the local patient advocacy group (NORA). We have produced 10 educational brochures on the most common rheumatic conditions for distribution across the country.
Based on this model, partnership between academic centers in the developed countries and academic centers in the developing countries can promote rheumatologic education and care in the developing countries. Fostering close working relationship among individuals of academic centers, local patient advocacy groups, and local government agencies are critical components of this model. Potential funding resources include professional societies, local government agencies, pharmaceutical industry and philanthropy. The impact of this intervention should be assessed by metrics such as disease activity scores, patient satisfaction surveys and assessment of standard of care.
Disclosure of Interest V. Ognenovski Grant/Research support from: ILAR, Consultant for: Roche
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