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Optimal care for rheumatoid arthritis: a focus group study

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Abstract

Our study sought to identify barriers to optimal care for individuals with rheumatoid arthritis (RA). Our study was set in a population with universal access to comprehensive health care in the context of a university hospital health network. Using purposive sampling, we invited RA patients, health professionals, and decision makers from urban and rural regions to participate in structured focus group interviews. Content analysis was performed to determine themes emerging from the data. We identified four general themes. First, initial barriers to optimal care for people begin before primary care contact, at the level of the general population and/or related to primary care access. Second, many factors (at the patient, physician, and system level) influenced how quickly a patient is referred from primary to specialty care. Third, after referral, multiple comanagement issues influence patient outcomes. Fourth, optimizing RA care requires adequate resources. Participants emphasized the need for more education (of patients, of health care providers, and within the general community), better communication between and among patients and health care providers, and more efficient use of existing resources. Our work provides insights regarding barriers to and facilitators of optimal care in RA. Further work with these stakeholder groups in our health care region will examine potential solutions and the feasibility of their implementation. Our work provides an example of how research can assist stakeholder leaders in creating structured and incremental plans to improve health care delivery for persons with chronic diseases like RA.

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References

  1. Aletaha D, Eberl G, Nell VPK, Machold KP, Smolen JS (2002) Practical progress in realisation of early diagnosis and treatment of patients with suspected rheumatoid arthritis: results from two matched questionnaires within three years. Ann Rheum Dis 61:630

    Article  CAS  PubMed  Google Scholar 

  2. Irvine S, Munro R, Porter D (1999) Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing medical practice. Ann Rheum Dis 58:510

    Article  CAS  PubMed  Google Scholar 

  3. Potter T, Mulherin D, Pugh M, Emery P, Quinn M, Conaghan P (2002) Early intervention with disease-modifying therapy for rheumatoid arthritis: where do the delays occur? Rheumatology 41:953

    Article  CAS  PubMed  Google Scholar 

  4. Feldman ED, Bernatsky S, Haggerty J, Leffondré K, Tousignant P, Roy Y (2007) Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study. Arthritis Rheum 57:1419–1425

    Article  PubMed  Google Scholar 

  5. Lacaille D, Anis AH, Guh DP, Esdaile JM (2005) Gaps in care for rheumatoid arthritis: a population study. Arthritis Rheum 53:241–248

    Article  PubMed  Google Scholar 

  6. Li LC, Badley EM, MacKay C, Mosher D, Jamal SW, Jones A et al (2008) An evidence-informed, integrated framework for rheumatoid arthritis care. Arthritis Rheum 59:1171–1183

    Article  PubMed  Google Scholar 

  7. Kumar K, Daley E, Carruthers DM, Situnayake D, Gordon C, Grindulis K et al (2007) Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 46:1438–1440

    Article  CAS  Google Scholar 

  8. Sandhu RS, Treharne GJ, Justice EA, Jordan AC, Saravana S, Obrenovic K et al (2008) Comment on: Delay in presentation to primary care physicians is the main reason why patients with rheumatoid arthritis are seen late by rheumatologists. Rheumatology (Oxford) 47:559–560

    Article  CAS  Google Scholar 

  9. Sheppard J, Kumar K, Buckley CD, Shaw KL, Raza K (2008) 'I just thought it was normal aches and pains': a qualitative study of decision-making processes in patients with early rheumatoid arthritis. Rheumatology (Oxford) 47:1577–1582

    Article  CAS  Google Scholar 

  10. Kravitz RL, Bell RA (2007) Direct-to-consumer advertising of prescription drugs: balancing benefits and risks, and a way forward. Clin Pharmacol Ther 82:360–362

    Article  CAS  PubMed  Google Scholar 

  11. Federal/Provincial/Territorial Ministerial Task Force on the National Pharmaceuticals Strategy. National Pharmaceutical Strategy Progress Report. Cat. H21-275/2006 ISBN 0-662-49443-1. 6-6-2006. Ottawa

  12. Glazier RH, Dalby DM, Badley EM, Hawker GA, Bell MJ, Buchbinder R et al (1998) Management of common musculoskeletal problems: a survey of Ontario primary care physicians. CMAJ 158:1037–1040

    CAS  PubMed  Google Scholar 

  13. Shipton D, Glazier RH, Guan J, Badley EM (2004) Effects of use of specialty services on disease-modifying antirheumatic drug use in the treatment of rheumatoid arthritis in an insured elderly population. Med Care 42:907–913

    Article  PubMed  Google Scholar 

  14. National Physician Survey, 2004: National Results for Rheumatologists. [Online] 2006. [cited 2008 Nov 20];Available from: URL:http://www.nationalphysiciansurvey.ca/nps/results/PDF-e/SP/Specialty/Rheum/Rheuma-G.pdf.

  15. Bernatsky S, Feldman D, Shrier I, Toupin K, Haggerty J, Tousignant P, Zummer M (2006) Care pathways in early rheumatoid arthritis. Can Fam Physician 52:1444–1445

    PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Guy Morissette and Mr. Jim Gates for their assistance with research planning; Mr. Andy Chabot, who with the Arthritis Society of Quebec was instrumental in the success of the focus group and workshop activities; and all of the participants in the focus group discussions and the follow-up workshops. Sasha Bernatsky is a Canadian Arthritis Network scholar and is supported by the Canadian Institutes of Health Research (CIHR), the Fonds de la recherche en santé du Québec (FRSQ), and the Department of Medicine of the Research Institute of the McGill University Health Centre.

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Authors and Affiliations

  1. Division of Rheumatology, McGill University Health Centre (MUHC), Montreal, QC, Canada

    Sasha Bernatsky

  2. Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre (RI-MUHC), Royal Victoria Hospital, 687 Pine Avenue West, V-Building, Room V2.09, Montreal, QC, H3A 1A1, Canada

    Sasha Bernatsky, Christopher Mill & Jennifer Lee

  3. Faculté de Médecine, Ecole de Réadaptation, Université de Montréal, Montreal, QC, Canada

    Debbie Feldman

  4. Direction de la Santé Publique de Montréal, Montreal, QC, Canada

    Debbie Feldman & Pierre Tousignant

  5. Knowledge Translation Consultancy Services, Montreal, QC, Canada

    Mirella De Civita

  6. Université de Sherbrooke, Sherbrooke, QC, Canada

    Jeannie Haggerty

  7. Alliance for the Canadian Arthritis Program, Vancouver, BC, Canada

    Jean Legaré

  8. Division of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada

    Michel Zummer

  9. Department of Medicine, McGill University, Montreal, QC, Canada

    Tim Meagher

  10. Department of Family Medicine, McGill University, Montreal, QC, Canada

    Mark Roper

Authors
  1. Sasha Bernatsky
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  2. Debbie Feldman
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  3. Mirella De Civita
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  4. Jeannie Haggerty
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  5. Pierre Tousignant
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  6. Jean Legaré
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  7. Michel Zummer
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  8. Tim Meagher
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  9. Christopher Mill
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  10. Mark Roper
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  11. Jennifer Lee
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Corresponding author

Correspondence to Sasha Bernatsky.

Electronic supplementary material

ESM 1

Supplementary material, methodology, optimal care for rheumatoid arthritis (DOC 34 kb)

Appendices

Appendix 1a: Front page of referral template developed as one solution to improve care trajectories

Appendix 1b: Back page of referral template developed as one solution to improve care trajectories

Adapted from Alberta Health Services, Calgary Health Region, Medical Specialists & Medical Services Central Access & Triage, www.departmentofmedicine.com/MAS/index.html

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Bernatsky, S., Feldman, D., De Civita, M. et al. Optimal care for rheumatoid arthritis: a focus group study. Clin Rheumatol 29, 645–657 (2010). https://doi.org/10.1007/s10067-010-1383-9

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  • DOI: https://doi.org/10.1007/s10067-010-1383-9

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