Physician Extenders Needed to Help Fill Gap in Arthritis Care

KANANASKIS, ALTA. — Rheumatologists' best hope for dealing with the coming deluge of joint disease is to use physician extenders to triage patients and oversee their physical therapy.

A report by the American College of Rheumatology has anticipated a significant shortage of rheumatologists that will begin after 2010 and continue for at least 20 years. In 2006, when the report was published, fellows of the ACR averaged 56 years of age. Rheumatology is one of many specialties with projected shortfalls of physicians that may reach 200,000 by 2025, according to the ACR (Arthritis Rheum. 2007;56:722–9).

“The challenge is in determining who is going to do what. Fortunately, we now have some evidence to show that doing things differently can help facilitate the delivery of these interventions to more people in a more timely manner,” Linda Li, Ph.D., said at the annual meeting of the Canadian Rheumatology Association.

Dr. Li and her associates developed an integrated framework for rheumatoid arthritis treatment to shorten the delays between various levels of care, based on a review of the literature (Arthritis Rheum. 2008;59:1171–83).

The framework begins at the community level, where health care services should provide information to patients during the interval between symptom onset and the first visit to a primary care physician. “Some interventions involve using community therapists, pharmacists, and nurses to facilitate the transition from community to primary care,” noted Dr. Li, the Harold Robinson/Arthritis Society Chair in Arthritic Diseases at the University of British Columbia, Vancouver.

One study looked at the use of community pharmacists to disseminate information about the relationship between knee pain and osteoarthritis (Arthritis Rheum. 2007;57:1238–44). A simple screening questionnaire found that 190 (98%) of 194 patients who indicated knee pain met ACR clinical criteria for knee osteoarthritis.

At the primary care level, where specially trained nurses triaged rheumatology referrals using standardized guidelines, the rate of appropriate referrals increased from 50% to 90% within 2 years (Rheumatology [Oxford] 2003;42:763–8).

Another study found that specially trained physical therapists reduced referrals to orthopedists by 17% and to rheumatologists by 8%, compared with the conventional model of direct referral from general practitioners to hospital departments (Am. J. Phys. Med. Rehabil. 2005;84:702–11).

Secondary care focuses on self-management and follow-up assessments, yet another area where nonphysicians can play a role in effective clinical care, Dr. Li said. This frees up rheumatologists to see the sickest people, she added.

Dr. Linda Li is supported by the Harold Robinson/Arthritis Society Chair in Arthritic Diseases, a Canadian Institutes of Health Research (CIHR) New Investigator Award, and an American College of Rheumatology Research & Education Foundation Health Professional New Investigator Award.

KANANASKIS, ALTA. — Rheumatologists' best hope for dealing with the coming deluge of joint disease is to use physician extenders to triage patients and oversee their physical therapy.

A report by the American College of Rheumatology has anticipated a significant shortage of rheumatologists that will begin after 2010 and continue for at least 20 years. In 2006, when the report was published, fellows of the ACR averaged 56 years of age. Rheumatology is one of many specialties with projected shortfalls of physicians that may reach 200,000 by 2025, according to the ACR (Arthritis Rheum. 2007;56:722–9).

“The challenge is in determining who is going to do what. Fortunately, we now have some evidence to show that doing things differently can help facilitate the delivery of these interventions to more people in a more timely manner,” Linda Li, Ph.D., said at the annual meeting of the Canadian Rheumatology Association.

Dr. Li and her associates developed an integrated framework for rheumatoid arthritis treatment to shorten the delays between various levels of care, based on a review of the literature (Arthritis Rheum. 2008;59:1171–83).

The framework begins at the community level, where health care services should provide information to patients during the interval between symptom onset and the first visit to a primary care physician. “Some interventions involve using community therapists, pharmacists, and nurses to facilitate the transition from community to primary care,” noted Dr. Li, the Harold Robinson/Arthritis Society Chair in Arthritic Diseases at the University of British Columbia, Vancouver.

One study looked at the use of community pharmacists to disseminate information about the relationship between knee pain and osteoarthritis (Arthritis Rheum. 2007;57:1238–44). A simple screening questionnaire found that 190 (98%) of 194 patients who indicated knee pain met ACR clinical criteria for knee osteoarthritis.

At the primary care level, where specially trained nurses triaged rheumatology referrals using standardized guidelines, the rate of appropriate referrals increased from 50% to 90% within 2 years (Rheumatology [Oxford] 2003;42:763–8).

Another study found that specially trained physical therapists reduced referrals to orthopedists by 17% and to rheumatologists by 8%, compared with the conventional model of direct referral from general practitioners to hospital departments (Am. J. Phys. Med. Rehabil. 2005;84:702–11).

Secondary care focuses on self-management and follow-up assessments, yet another area where nonphysicians can play a role in effective clinical care, Dr. Li said. This frees up rheumatologists to see the sickest people, she added.

Dr. Linda Li is supported by the Harold Robinson/Arthritis Society Chair in Arthritic Diseases, a Canadian Institutes of Health Research (CIHR) New Investigator Award, and an American College of Rheumatology Research & Education Foundation Health Professional New Investigator Award.

KANANASKIS, ALTA. — Rheumatologists' best hope for dealing with the coming deluge of joint disease is to use physician extenders to triage patients and oversee their physical therapy.

A report by the American College of Rheumatology has anticipated a significant shortage of rheumatologists that will begin after 2010 and continue for at least 20 years. In 2006, when the report was published, fellows of the ACR averaged 56 years of age. Rheumatology is one of many specialties with projected shortfalls of physicians that may reach 200,000 by 2025, according to the ACR (Arthritis Rheum. 2007;56:722–9).

“The challenge is in determining who is going to do what. Fortunately, we now have some evidence to show that doing things differently can help facilitate the delivery of these interventions to more people in a more timely manner,” Linda Li, Ph.D., said at the annual meeting of the Canadian Rheumatology Association.

Dr. Li and her associates developed an integrated framework for rheumatoid arthritis treatment to shorten the delays between various levels of care, based on a review of the literature (Arthritis Rheum. 2008;59:1171–83).

The framework begins at the community level, where health care services should provide information to patients during the interval between symptom onset and the first visit to a primary care physician. “Some interventions involve using community therapists, pharmacists, and nurses to facilitate the transition from community to primary care,” noted Dr. Li, the Harold Robinson/Arthritis Society Chair in Arthritic Diseases at the University of British Columbia, Vancouver.

One study looked at the use of community pharmacists to disseminate information about the relationship between knee pain and osteoarthritis (Arthritis Rheum. 2007;57:1238–44). A simple screening questionnaire found that 190 (98%) of 194 patients who indicated knee pain met ACR clinical criteria for knee osteoarthritis.

At the primary care level, where specially trained nurses triaged rheumatology referrals using standardized guidelines, the rate of appropriate referrals increased from 50% to 90% within 2 years (Rheumatology [Oxford] 2003;42:763–8).

Another study found that specially trained physical therapists reduced referrals to orthopedists by 17% and to rheumatologists by 8%, compared with the conventional model of direct referral from general practitioners to hospital departments (Am. J. Phys. Med. Rehabil. 2005;84:702–11).

Secondary care focuses on self-management and follow-up assessments, yet another area where nonphysicians can play a role in effective clinical care, Dr. Li said. This frees up rheumatologists to see the sickest people, she added.

Dr. Linda Li is supported by the Harold Robinson/Arthritis Society Chair in Arthritic Diseases, a Canadian Institutes of Health Research (CIHR) New Investigator Award, and an American College of Rheumatology Research & Education Foundation Health Professional New Investigator Award.