Telerheumatology Shared-Care Model: Leveraging the Expertise of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-Trained Extended-Role-Practitioner (ERP) in Rural-Remote Ontario.

A shortage of Rheumatologists has led to gaps in inflammatory arthritis (IA) care in Canada. Amplified in rural-remote communities, the number of Rheumatologists practicing rurally has not been meaningfully increased and alternate care strategies must be adopted. In this retrospective chart review, we describe the impact of a shared-care Telerheumatology model, utilizing a community-embedded Advanced Clinician Practitioner in Arthritis Care (ACPAC)-ERP and an urban-based Rheumatologist. A Rheumatologist and an ACPAC-ERP established a monthly half-day Hub-and-Spoke-Telerheumatology clinic to care for patients with suspected IA, triaged by the ACPAC-ERP. Comprehensive initial assessments were conducted in-person by the ACPAC-ERP (Spoke); investigations were completed prior to the Telerheumatology visit. Subsequent collaborative visits occurred with the Rheumatologist (Hub) attending virtually. Retrospective analysis of demographics, time-to-key-care-indices, patient-reported outcomes, clinical data, and estimated travel savings was performed. Data from 124 patients seen between January 2013-January 2022 were collected: 98.0% (n=494/504 visits) were virtual. Average age at first visit was 55.6 years, 75.8% were female. IA/Connective Tissue Disease (CTD) disease was confirmed in 65.0% patients. Mean time from primary care referral to ACPAC-ERP assessment was 52.5 days, and mean time from ACPA-ERP assessment to the Telerheumatology visit was 64.5 days. An estimated 493,470 km of patient-related travel was avoided. An ACPAC-ERP (Spoke) and Rheumatologist (Hub) Telerheumatology model of care assessing and managing patients with suspected IA in rural/remote Ontario was described. This model can be leveraged to increase capacity by delivering comprehensive virtual rheumatologic care in underserved communities.