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Patient, Rheumatologist and Therapist Perspectives on the Implementation of an Allied Health Rheumatology Triage (AHRT) Initiative in Ontario Rheumatology Clinics

Authors Fullerton LM, Brooks S, Sweezie R, Ahluwalia V, Bombardier C, Gagliardi AR

Received 8 May 2019

Accepted for publication 15 October 2019

Published 28 January 2020 Volume 2020:11 Pages 1—12

DOI https://doi.org/10.2147/POR.S213966

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor David Price


Laura M Fullerton,1 Sydney Brooks,2 Raquel Sweezie,2 Vandana Ahluwalia,3 Claire Bombardier,4 Anna R Gagliardi4

1Ontario Best Practices Research Initiative, Toronto General Research Institute, Toronto, ON, Canada; 2Ontario Division, Arthritis Society, Toronto, ON, Canada; 3Department of Rheumatology, William Osler Health System, Brampton, ON, Canada; 4Toronto General Research Institute, University of Toronto, Toronto, ON, Canada

Correspondence: Sydney Brooks
Arthritis Society, 393 University Avenue, Suite 1700, Toronto M5G 3E6, Canada
Tel +416 979-7228
Fax +416 979-8366
Email sbrooks@arthritis.ca

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.

Keywords: health service needs and demand, rheumatic diseases, connective tissue disease, patient satisfaction

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