An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice.
community health services
health services accessibility
integrated delivery systems
interprofessional relations
rheumatology
Journal
Journal of multidisciplinary healthcare
ISSN: 1178-2390
Titre abrégé: J Multidiscip Healthc
Pays: New Zealand
ID NLM: 101512691
Informations de publication
Date de publication:
2019
2019
Historique:
entrez:
22
1
2019
pubmed:
22
1
2019
medline:
22
1
2019
Statut:
epublish
Résumé
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. 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. 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). A well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.
Identifiants
pubmed: 30662267
doi: 10.2147/JMDH.S183397
pii: jmdh-12-063
pmc: PMC6327890
doi:
Types de publication
Journal Article
Langues
eng
Pagination
63-71Déclaration de conflit d'intérêts
Disclosure The authors report no conflicts of interest in this work.
Références
Healthc Q. 2015;18(3):7-10
pubmed: 26718246
J Rheumatol. 2011 Jul;38(7):1282-8
pubmed: 21572157
Open Access Rheumatol. 2015 Aug 19;7:45-53
pubmed: 27790044
Hum Resour Health. 2015 May 28;13:41
pubmed: 26016670
Physiother Can. 2011 Winter;63(1):94-103
pubmed: 22210986
Ann Rheum Dis. 2013 Jan;72(1):13-22
pubmed: 22532640
J Rheumatol. 2012 Nov;39(11):2088-97
pubmed: 22896027
Physiother Can. 2011 Fall;63(4):434-42
pubmed: 22942521
Ann Rheum Dis. 2012 Mar;71(3):363-8
pubmed: 21989539
Arthritis Care Res (Hoboken). 2015 Feb;67(2):230-9
pubmed: 25048206
Clin Rheumatol. 2011 Mar;30 Suppl 1:S33-9
pubmed: 21350796
J Rheumatol. 2020 Mar;47(3):461-467
pubmed: 31154411
Arthritis Rheum. 2010 Dec;62(12):3519-21
pubmed: 20722032
Open Access Rheumatol. 2012 May 30;4:49-55
pubmed: 27790011
J Eval Clin Pract. 2009 Feb;15(1):178-83
pubmed: 19239599
J Rheumatol. 2016 Nov;43(11):2064-2067
pubmed: 27585684
Healthc Policy. 2013 May;8(4):56-70
pubmed: 23968638
Physiother Can. 2013 Fall;65(4):358-63
pubmed: 24396164
Arthritis Care Res (Hoboken). 2017 Jan;69(1):104-114
pubmed: 27110847
Nurs Res Pract. 2011;2011:376020
pubmed: 21994825
Healthc Q. 2008;11(3):62-8
pubmed: 18536536
J Occup Environ Med. 2006 Feb;48(2):135-48
pubmed: 16474262
J Interprof Care. 2008 Jun;22(3):253-61
pubmed: 18569412
J Interprof Care. 2013 Sep;27(5):401-7
pubmed: 23679675
Can J Public Health. 2013 Oct 31;104(7):e450-5
pubmed: 24495819
Ann Rheum Dis. 2015 Apr;74(4):738-45
pubmed: 24406543
J Rheumatol. 2017 Feb;44(2):248-257
pubmed: 27909087