Spring 2020 (Volume 30, Number 1)

CIORA – A Sampling of Grants

At the most recent CRA Annual Scientific Meeting in February, Dr. Deborah Marshall and Ms. Laura Passalent presented their CIORA grants. Read on for more below.

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Geographic Variation in Rheumatoid Arthritis (RA) Addressing Inequities in Access to Care
Presented by Deborah Marshall, on behalf of Xiaoxiao Liu, Stefania Bertazzon, Alka B. Patel, Dianne Mosher, Joanne Homik, Steven Katz, Christopher Smith, Jill Robert, and Claire E.H. Barber

Timely access to rheumatologists and equitable access to care remain a challenge, especially in Canada, where patients living in rural areas may need to travel long distances for care from specialists who are clustered in urban areas. Estimates of rheumatologists per capita do not provide sufficient information for determining gaps in rheumatology services due to the wide geographic distribution of patients with RA. Using geospatial analysis, our team assessed the geographic variability in RA prevalence across the rural urban continuum.

When analysed at the local geographic area level with 132 defined areas, we found a five-fold difference in RA prevalence. At the local geographic area level, we identified seven ‘hotspots’ (areas with clustered high prevalence rates) in rural and remote areas. These variations have the potential to create disparities in access to RA care, which should be considered when designing evidence-based interventions and planning programs to improve access to associated healthcare services and reduce inequities. Future work will examine geographic accessibility and social economic factors with respect to health care utilization and health outcomes, which may further help understand the rural-urban disparities and provide guidance for planning health services for patients with RA.

Deborah A Marshall is the Arthur J.E. Child Chair of Rheumatology Outcomes Research and former Canada Research Chair, Health Services and Systems Research (2008-2018). She is a professor at the University of Calgary.

Adult axial spondyloarthritis (axSpA) screening and referral practices amongst primary care physicians, nurse practitioners, physiotherapists and chiropractors working in community practice in the province of Ontario
Presented by Laura Passalent, on behalf of Christopher Hawke, Jeff Bloom, Andrew Bidos, Leslie Soever, Raj Rampersaud, Nigil Haroon and Robert D. Inman.

This multi-phase project examined primary care providers’ clinical knowledge and screening and referral practices for patients with suspected axSpA. Primary care providers included family physicians (MDs), nurse practitioners (NPs), physiotherapists (PTs) and chiropractors (DCs) practicing in Ontario.

Phase 1: Semi-structured key informant interviews were conducted with 17 primary care providers. Screening practice themes included: clinical knowledge of axSpA; role of investigations and awareness of screening tools. Referral practice themes included: technology optimization; referral barriers and legislative hurdles.

Phase 2: Licensed primary care providers were electronically surveyed using a questionnaire developed from Phase 1 results. There were 276 respondents. Morning stiffness > 30 minutes and HLA-B27 presence were considered “very important” clinical features of axSpA. Most respondents “never used” or “were not familiar” with axSpA screening tools. MDs/NPs “always” or “often” refer to rheumatology, although wait times were identified as a substantial barrier. PTs and DCs “always” or “often” refer patients to their MD/NP to facilitate investigation and/or rheumatology referral.

The combined results suggest primary care providers have reasonable clinical knowledge of axSpA. There is little awareness of axSpA screening tools. PTs/DCs identified screening and referral barriers related to scope of practice that, if mitigated, may allow for better early detection. Targeted education strategies may improve axSpA screening and referral practices in primary care.

Laura Passalent, BScPT, MHSc, ACPAC, is a lecturer in the Department of Physical Therapy, in the Faculty of Medicine at the University of Toronto, and is a physiotherapist practitioner with the Arthritis Program at the Toronto Western Hospital. She is also a clinician investigator with the Krembil Research Institute.


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