Fall 2026 (Volume 36, Number 3)

Right Care, Right Time: Reimagining Rheumatology Follow-Up Through Appointments by Choice

By Claire E.H. Barber, MD, PhD, FRCPC

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Rheumatology services across Canada face increasing pressure from workforce shortages, growing patient volumes, and long wait times. Traditional follow-up models often require patients to attend routine appointments every 6 to 12 months, regardless of disease activity or clinical need. Yet studies suggest that 20-50% of these visits may not result in treatment changes, highlighting opportunities to better align care delivery with patient needs.¹

Appointments by Choice (ABC) is a patient-initiated follow-up model designed to address these challenges.^2,3 Developed through extensive engagement with patients, clinicians, and health system leaders,⁴ ABC shifts care from routinely scheduled visits to a system where patients access rheumatology services when they need them.

Eligible patients with stable rheumatoid arthritis (RA) extend routine rheumatologist follow-up intervals, often to 24 months, while maintaining rapid access to care through a clearly defined pathway. The model includes patient education, shared decision-making tools, and a pharmacist-led model supporting rapid access to care when needed for flares or changes in health status.

A pilot implementation launched in 2024 within a multi-physician rheumatology clinic. Early results demonstrate strong feasibility and acceptability. Of 140 eligible patients, 76 (54%) enrolled, and nearly 90% remained in the program over 18 months. Safety outcomes have been reassuring, with only 7% of participants requiring a return to standard scheduled follow-up because of disease flares or changing clinical circumstances. Patients consistently reported high satisfaction, particularly appreciating reduced travel requirements and rapid access to support when concerns arose.

Key Impact: ABC reduced routine follow-up visits, freeing approximately 1,520 minutes of rheumatologist time, equivalent to 38 new patient consultations.

These early findings suggest that patient-initiated follow-up can safely improve access, enhance patient experience, and optimize specialist capacity. As healthcare systems continue to seek sustainable solutions, ABC offers a promising model for delivering high-quality, patient-centred rheumatology care while preserving timely access for patients with the greatest need.

Project Team:
C.E.H. Barber, MD, PhD, FRCPC
A. Charlton, PharmD
M. Ester, PhD
Glen Hazlewood, MD, PhD, FRCPC
Michelle Jung, MD, FRCPC
Erin Carter, MD, FRCPC
Dianne Mosher, MD, FRCPC
Krista White, MA
Ann Rebutoc, MSc
Kiran Dhiman, MPH
Sarah Manske, PhD
Alison Hoens, PT, MSc
Monika Szpunar, PhD
Gabrielle Zimmerman, PhD and
Diane Lacaille, MD, MHSc, FRCPC

Acknowledgements: We thank participating patients and the rheumatology leadership, administrative, and clinic teams at Richmond Road Diagnostic & Treatment Centre.

Funding: Supported by CIORA (Canadian Initiative for Outcomes in Rheumatology Care), the Grace Glaum Professorship in Arthritis Research (Dr. Barber), and a CIHR Health System Impact Fellowship (Dr. Ester).

References:

1. Subdar S, Dhiman K, Hartfeld NMS, et al. Investigating the Influence of Patient Eligibility Characteristics on the Number of Deferrable Rheumatologist Visits: Planning for a Patient-Initiated Follow-Up Strategy. J Rheumatol. 2024 Jun 1;51(6):587-595. doi: 10.3899/jrheum.2023-0891. PMID: 38302163.

2. Bhangu G, Hartfeld NMS, Lacaille D, et al. A scoping review of shared care models for rheumatoid arthritis with patient-initiated follow-up. Semin Arthritis Rheum. 2023 Jun;60:152190. doi: 10.1016/j.semarthrit.2023.152190. Epub 2023 Mar 11. PMID: 36934470.

3. Warkentin L, Moga C, Sajida S. Institute of Health Economics. Patient-initiated follow up in ambulatory secondary care: rapid review. Edmonton (AB): Institute of Health Economics; 2024. Available at https://ihe.ca/files/patient_initiated_follow_up_in_ambulatory_secondary_care.pdf. Accessed August 11, 2026.

4. Ester M, White K, Dhiman K, et al. A theory of change for patient-initiated follow-up care in rheumatoid arthritis. BMC Rheumatol. 2025 Mar 12;9(1):31. doi: 10.1186/s41927-025-00481-3. PMID: 40075469; PMCID: PMC11899900.