Spring 2018 (Volume 28, Number 1)

A Call to Action:
New Models of Care in Inflammatory Arthritis and Osteoarthritis

By Michel Zummer, MD, FRCPC; and Gillian Hawker, MD, MSc, FRCPC

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In 2012, the Arthritis Alliance of Canada (AAC) decided to prioritize the development of a framework for models of care for arthritis. The overarching goal was to define a care path for people presenting with musculoskeletal symptoms. The first step was to create the Tool for Developing and Evaluating Models of Care (2012) to validate the components of a proposed Model of Care.

More than 150 stakeholders collaborated to produce A pan-Canadian Approach to Inflammatory Arthritis Models of Care (2014). The six key elements of the framework are shown in the figure below (adapted from the Ontario Rheumatology Association [ORA] Rheumatology Model of Care Framework).

Efforts were next directed at disseminating the model amongst the various stakeholders to document and tailor the components that would be adopted. Quality measurement projects have also been initiated.

Initially developed for inflammatory arthritis, other musculoskeletal conditions including osteoarthritis (OA) were subsequently integrated into the model to expand its applicability. Osteoarthritis is the most common type of arthritis, with a substantial societal burden. Barriers to optimal OA diagnosis and treatment include the societal belief that OA reflects normal aging, and the high co-prevalence of OA with other chronic conditions, which represent competing demands and make treatment challenging.

Recognizing these barriers and the need to do better for OA patients, a partnership was established between the AAC, the College of Family Physicians of Canada (CFPC) and the Centre for Effective Practice to integrate previously identified standards of OA prevention and management into primary care. A toolkit for primary care providers was developed to assist family physicians and other healthcare providers to effectively identify, assess, diagnose and manage OA. The Tool is available at

Work is ongoing to increase awareness of the tool and to evaluate strategies for its effective and efficient implementation into primary care.

Dr. Michel Zummer, Associate Professor, Université de Montréal;
Rheumatologist, CH Maisonneuve-Rosemont, Montréal, QC

Dr. Gillian Hawker, Sir John and Lady Eaton Professor, Department of
Medicine, Division of Rheumatology, University of Toronto, Toronto, ON


1. Arthritis Alliance of Canada. Pan-Canadian Approach to IA Models of Care. Available at Accessed March 2018.

2. Arthritis Alliance of Canada. Unprecedented national standards on arthritis prevention and care delivered to federal and provincial health ministers. News release: 6 April 2006. Available at

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