Spring 2019 (Volume 29, Number 1)
CIORA Project
Showcase
By Janet Pope, MD, MPH, FRCPC
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At the most recent CRA Annual Scientific Meeting in
February, Drs. Barry Koehler, Inés Colmegna, and
Regina Taylor-Gjevre presented their CIORA grant
reports. In this issue’s CIORA column, we’d like to share the
three CIORA projects that were highlighted in Montreal.
The projects were showcased to provide attendees an opportunity
to hear about successful CIORA grants by both
community and academic rheumatologists.
Self-assessment Triage in Inflammatory Arthritis:
A Pilot Study
Presented by Dr. Barry Koehler
The study performed a comparison of a patient-completed
questionnaire vs. a patient-completed tender joint count
vs. the two combined, to evaluate whether patients with
inflammatory arthritis can be identified from waiting lists.
The study group feels that the use of preliminary studies,
biostatistical advice before and during the study, and regular
communication throughout the study were responsible
for obtaining CIORA approval and for successful patient
enrollment and data collection. A total of 202 evaluable
subjects were enrolled and results are in the process of
analysis.
What Do People Living with Rheumatoid Arthritis
and Their Health-care Providers Consider Barriers or
Facilitators for Influenza Vaccine Uptake?
Presented by Dr. Inés Colmegna
Influenza vaccine is effective. It prevents illnesses, reduces
medical visits and hospitalizations, and decreases death
rates due to influenza. The goals for influenza vaccine coverage
suggested by the Public Health Agency of Canada
are 80% for adults older than age 65 years and for those
younger than 65 years living with high-risk conditions.
However, a CIORA-funded cross-sectional study at McGill
University Health Care Center found a 48.5% rate of vaccination
coverage in rheumatoid arthritis (RA). Although
this is above the reported rate (37%) for Canadian adults
≤ 65 years of age living with chronic medical conditions,
there is a clear need and an opportunity to improve vaccination
coverage among rheumatic patients.
At the national level, the advice of a health-care provider
to people with chronic medical conditions was associated
with vaccine uptake. However, 48% of patients
with chronic conditions reported that their reason for not
getting the influenza vaccine was that it was “not needed
or recommended.” Similarly, in our study, the MD recommendation
was the strongest independent predictor of
influenza vaccination among RA patients. This highlights
our unique role as rheumatologists in improving vaccine
uptake.
What are the barriers and facilitators to optimizing
influenza vaccine uptake among RA patients? This is the
central question that we addressed through qualitative research
(focus groups) with the support of CIORA. Perceived
barriers and facilitators of vaccine acceptance were similar
in RA patients and their health-care providers. Main barriers
included lack of knowledge, understanding, or misinformation
regarding the need for the influenza vaccine.
What interventions are effective in increasing vaccine acceptance
in RA? This was the topic of a systematic review
to inform the development of a targeted motivational communication
intervention that we will test in the upcoming
influenza season.
In summary, thanks to the generous support of CIORA
we have defined the existence of a gap in influenza vaccine
uptake among RA patients; identified reasons that patients
and providers endorse related to that problem, and
reviewed the limited existing evidence on interventions to
enhance vaccine acceptance. Furthermore, we have developed
a novel intervention based on motivational communication
that will be tested in the 2019-2020 influenza
season. From describing the magnitude of the problem, to
proposing approaches to reduce its burden on RA patients,
this has been an amazing learning opportunity.
Addressing Rural and Remote Access Disparities
for Patients with Inflammatory Arthritis through
Telehealth/Videoconferencing and Innovative
Inter-professional Care Models
Presented by Dr. Regina Taylor-Gjevre
In Saskatchewan, there is a relatively high proportion of the
provincial population who reside in isolated smaller communities.
We undertook a study to evaluate whether rheumatoid
arthritis patients followed longitudinally for nine
months, using videoconferencing and inter-professional
support, have comparable disease control to those followed
in traditional in-person clinics.
Of 85 participants, 54 were randomized to the videoconferencing
care model and 31 to the traditional clinic.
There were no significant between-group differences in
DAS28-CRP, RADAI, mHAQ or EQ5D scores at baseline or
over the study period. Satisfaction rates were high in both
groups.
At study completion, we found no difference in effectiveness
between inter-professional videoconferencing care
and a traditional rheumatology clinic. High drop-out rates
reinforced the need for consideration of patients’ needs
and preferences. While use of videoconferencing/telehealth
technologies may be a distinct advantage for some,
there may be a loss of travel-related auxiliary benefits for
others. The report on this study is currently published in
the Journal of Musculoskeletal Care.
Janet Pope, MD, MPH, FRCPC
Professor of Medicine, Division Head, Division of Rheumatology,
Department of Medicine, St. Joseph’s Health Care,
Western University
London, Ontario
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