Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

Human Resources for Health

Deborah Marshall⁴  Theresa Lupton⁶  Jennifer Hendricks⁷  Jane Squire Howden¹  Stephen Weiss²  Renee Misfeldt⁵  Paola Charland³  Arden Birney³  Esther Suter³ 

[1] Edmonton Musculoskeletal Centre, Suite 2068, 9499 137 Avenue NW, Edmonton, T5E 5R8, Alberta, Canada;Alberta Bone and Joint Health Institute, 400, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada;Workforce Research & Evaluation, Alberta Health Services, 10301 Southport Lane SW, Calgary, T2W 1S7, Alberta, Canada;Alberta Bone and Joint Health Institute and Department of Community Health Sciences and Department of Medicine, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Alberta, Canada;Workforce Research & Evaluation, Alberta Health Services, 2nd floor, Collin Barrows Building 3942 50A Avenue, Red Deer, T4N 6H2, Alberta, Canada;Division of Rheumatology, Alberta Health Services, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Road SW, Calgary, T2T 5C7, Alberta, Canada;The Alberta Hip and Knee Clinic, Gulf Canada Square, Suite 335, 401- 9th Avenue, SW, Calgary, T2P 3C5, Alberta, Canada

关键词: Workforce planning;    Scope of practice;    Rheumatoid disease;    Osteoarthritis;    Interprofessional;    Centralized intake;    Case study;    Arthritis;    Access;   

Others  :  1209180
DOI  :  10.1186/s12960-015-0033-3

 received in 2014-12-11, accepted in 2015-05-17,  发布年份 2015

【 摘 要 】

Introduction

This case study was part of a larger programme of research in Alberta that aims to develop an evidence-based model to optimize centralized intake province-wide to improve access to care. A centralized intake model places all referred patients on waiting lists based on severity and then directs them to the most appropriate provider or service. Our research focused on an in-depth assessment of two well-established models currently in place in Alberta to 1) enhance our understanding of the roles and responsibilities of staff in current intake processes, 2) identify workforce issues and opportunities within the current models, and 3) inform the potential use of alternative providers in the proposed centralized intake model.

Case description

Our case study included two centralized intake models in Alberta associated with three clinics. One model involved one clinic that focuses on rheumatoid disease. The other model involved two clinics that focus on osteoarthritis. We completed a document review and interviews with managers and staff from both models. Finally, we reviewed the scope of practice regulations for a range of health-care providers to examine their suitability to contribute to the centralized intake process of osteoarthritis and rheumatoid disease.

Discussion and evaluation

Interview findings from both models suggested a need for an electronic medical record and eReferral system to improve the efficiency of the current process and reduce staff workload. Staff interviewed also spoke of the need to have a permanent musculoskeletal screener available to streamline the intake process for osteoarthritis patients. Both models relied on registered nurses, medical office assistants, and physicians throughout their intake process. Our scope of practice review revealed that several providers have the competencies to screen, assess, and provide case management at different junctures in the centralized intake of patients with osteoarthritis and rheumatoid disease.

Conclusions

Using a broader range of providers in the centralized intake of osteoarthritis and rheumatoid disease has the potential to improve access and care specifically related to the assessment and management of patients. This may enhance the patient care experience and address current access issues.

【 授权许可】

   
2015 Suter et al.; licensee BioMed Central.

【 参考文献 】

• [1]Arthritis Alliance of Canada. The impact of arthritis in Canada: today and over the next 30 years. 2011. http://www.arthritisalliance.ca/images/PDF/eng/Initiatives/20111022_2200_impact_of_arthritis.pdf. Accessed 25 Sept 2014.
• [2]The Arthritis Society. Arthritis in Canada: facts and figures. 2014. http://www.arthritis.ca/document.doc?id=925. Accessed 25 Sept 2014.
• [3]Kaptein S, Gignac M, Badley E. Differences in the workforce experiences of women and men with arthritis disability: a population health perspective. Arthritis Rheuma (Arthritis Care Res). 2009; 61:605-13.
• [4]Li X, Gignac M, Anis A. The indirect costs of arthritis resulting from unemployment, reduced performance and occupational changes while at work. Med Care. 2006; 44:304-10.
• [5]Gillam MH, Lie SA, Salter A, Furnes O, Graves SE, Havelin LI et al.. The progression of end-stage osteoarthritis: analysis of data from the Australian and Norwegian joint replacement registries using a multi-state model. Osteoarthritis and Cartilage. 2013.
• [6]Vanderby SA, Carter MW, Noseworthy T, Marshall DA. Modeling the complete continuum of care using system dynamics: the case of osteoarthritis in Alberta. J Simul. 2015.
• [7]Hanly J. Manpower in Canadian academic rheumatology units: current status and future trends. J Rheumatol. 2001; 28:1944-51.
• [8]Badley EM, Davis AM. Meeting the challenge of the ageing of the population: issues in access to specialist care for arthritis. Best Practice Res Clin Rheumatol. 2012; 26:599-609.
• [9]Comeau P. Crisis in orthopedic care: surgeon and resource shortage. Can Med Assoc J. 2004; 171:223.
• [10]Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg. 2011; 93:863-70.
• [11]Marshall D, Enns E, Vanderby S, Frank C, Wasylak T, Mosher D et al.. Estimating incidence and prevalence of osteoarthritis (OA) in Alberta using administrative claims data. Value Health. 2013; 21 Suppl:S164.
• [12]Hawker G, Bohm E, Connor-Spady B, De Coster C, Dunbar M, Hennigar A, et al. Perspectives of Canadian stakeholders on criteria for appropriateness for total joint arthroplasty in patients with hip and knee osteoarthritis. Arthritis & Rheumatology. 2015; In press.
• [13]Li LC, Badley EM, MacKay C, Mosher D, Jamal S, Jones A et al.. An evidence-informed, integrated framework for rheumatoid arthritis care. Arthritis Rheuma. 2008; 59:1171-83.
• [14]Doerr C, Graves S, Mercer G, Osborne R. Implementation of a quality care management system for patients with arthritis of the hip and knee. Aust Health Rev. 2013; 37:88-92.
• [15]Chao J, Kalunian K. Managing osteoarthritis. A multidisciplinary approach. J Musculoskelet Med. 2010; 27:1-8.
• [16]Choy E, Scott D, Kingsley G, Williams P, Wojtulewski J, Papasavvas G et al.. Treating rheumatoid arthritis early with disease modifying drugs reduces joint damage: a randomised double blind trial of sulphasalzaine vs diclofenac sodium. Clin Exp Rheumatol. 2002; 20:351-8.
• [17]Villaneuve E, Nam JL, Bell MJ, Deighton CM, Felson DT, Hazes JM et al.. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis. 2014; 72:13-22.
• [18]Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology. 2013; 52:99-110.
• [19]Marshall DA, Burgos-Liz L, Maarten JI, Osgood ND, Padula WV, Higashi MK et al.. Applying dynamic simulation modeling methods in health care delivery research – the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force. Value Health. 2015; 18:5-16.
• [20]Maddison P, Jones J, Breslin A, Barton C, Fleur J, Lewis R et al.. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. Br Med J. 2004; 329:1325-7.
• [21]Bichel A, Erfle S, Wiebe V, Axelrod D, Conly J. Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Quar. 2009; 13:61-8.
• [22]Frank C, Marshal D, Faris P, Smith C. Essay for the CIHR/CMAJ Award: improving access to hip and knee replacement and its quality by adopting a new model of care in Alberta. Can Med Assoc J. 2011.
• [23]Crabtree BF, Miller WL. Researching practice settings: a case study approach. In: Doing qualitative research. 2nd ed. Crabtree BF, Miller WL, editors. Sage Publications, Thousand Oaks, CA; 1999: p.293-312.
• [24]Yin RK. The case study anthology. Sage Publications, Thousand Oaks, CA; 2006.
• [25]Patton MQ. Qualitative evaluation and research methods. 2nd ed. Sage Publications, Newbury Park; 1990.
• [26]Tongco D. Purposive sampling as a tool for informant selection. Ethnobotany Res Appl. 2007; 5:147-58.
• [27]Crabtree BF, Miller WL. Sampling in qualitative inquiry. In: Doing qualitative research. 2nd ed. Crabtree BF, Miller WL, editors. Sage Publications, Thousand Oaks, CA; 1999: p.33-46.
• [28]Thomas D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006; 27:237-46.
• [29]College & Association of Registered Nurses of Alberta. Nurse practitioner (NP) competencies. 2011. Accessed 1 Jul 2014. http://www.nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Standards/NP_Competencies_Jan2011.pdf.
• [30]Physiotherapy Alberta College & Association. Standards of practice for Alberta physiotherapists. 2012. Accessed 1 Jul 2014. http://www.physiotherapyalberta.ca/files/practice_standards_all_2012_revised.pdf.
• [31]Alberta College and Association of Chiropractors. Standards of practice. 2014. Accessed 1 Jul 2014. http://www.albertachiro.com/ieadmin/files/ACAC_Standards_of_Practice.pdf.
• [32]Alberta College of Occupational Therapists. Standards of practice. 2003. Accessed 1 Jul 2014. http://www.acot.ca/files/Standards_of_Practice.pdf.
• [33]Alberta College of Occupational Therapists. Essential competencies of practice for occupational therapists in Canada. 2003. Accessed 1 Jul 2014. http://www.acot.ca/files/Essential_Competencies_of_Practice.pdf.
• [34]Arthritis Alliance of Canada. A pan-Canadian approach to inflammatory arthritis models of care. 2014. Accessed 9 Oct 2014. http://www.arthritisalliance.ca/images/PDF/eng/20140430-2030-IA-MOCFINAL.pdf.
• [35]Kur J, Koehler B. Rheumatologist demographics in British Columbia: a looming crisis. Br Columbia Med J. 2011; 53:128-31.
• [36]Speed CA, Crisp AJ. Referrals to hospital-based rheumatology and orthopaedic services: seeking direction. Rheumatology. 2005; 44:469-71.
• [37]MacKay C, Veinot P, Badley E. Characteristics of evolving models of care for arthritis: a key informant study. BMC Health Serv Res. 2008; 8:146-56.
• [38]Deloitte and Touche LLP. Evaluation of central intake and assessment centres for hip and knee replacement: final report. 2011. Accessed 16 Jul 2014. http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB0QFjAA&url=http%3A%2F%2Fwww.southeastlhin.on.ca%2F~%2Fmedia%2Fsites%2Fse%2FUploadedFiles%2FHSP%2FProjectsInitiatives%2F6%2520-%2520CIAC%2520Hip%2520and%2520Knee%2520Final%2520Report%2520Exec%2520Summ.pdf&ei=OGRnVby9CJbqoATJ5oAY&usg=AFQjCNGVDrxs-lwG3U8_r2nlbRZkLUEzyw.
• [39]Solomon DH, Bitton A, Fraenkel L, Brown E, Tsao P, Katz JN. Roles of nurse practitioners and physicians assistants in rheumatology practices in the US. Arthritis Care Res. 2014; 66:1108-13.
• [40]Ontario Chiropractic Association. Innovative models of care in Ontario. 2013. Accessed 9 Oct 2014. https://d2oovpv43hgkeu.cloudfront.net/Collaboration/Chiropractic-Collaboration-Innovative-Models-of-Care-in-Ontario.pdf.
• [41]Marion C, Balfe L. Potential advantages in interprofessional care in rheumatoid arthritis. J Manag Care Pharm. 2011; 17 Suppl B:S25-9.
• [42]Walker J. Rheumatoid arthritis: role of the nurse and multidisciplinary team. Br J Nurs. 2012; 21:334-9.
• [43]Lundon K, Shupak R, Reeves S, Schneider R, McIlroy JH. The advanced clinician practitioner in arthritis care program: an interprofessional model for transfer of knowledge for advanced practice practitioners. J Interprof Care. 2009; 23:198-200.