Working smart: Model behaviour

Creative thinking is making a difference in addressing concerns arthritis patients have about access to, and training of, health care professionals.

I had the privilege of attending the Canadian Rheumatology Association’s Annual Meeting in Mont Tremblant, Quebec this winter. Despite two snowstorms, the conference got under way and participants had the option to attend several clinical workshops. I chose the Profiling Models of Care workshop.

Terri Lupton, who is a nurse clinician at Calgary Health Region, presented the Rheumatology Central Triage model used in the city of Calgary. This program was developed by the University of Alberta Rheumatology Department and had general practitioners move away from the fee for service model to a comprehensive care model. All fourteen rheumatologists in the division participate in this program with the objectives being to improve access to care, patient self-management, and quality of care for patients with rheumatic diseases, and cost effectiveness.

All referrals sent to central triage are entered in a central database where they are coded and evaluated for urgency. A tentative schedule is then assigned to the requested rheumatologist or the next available rheumatologist.

The advantage of the triage process is that it provides a database of all referrals, tracks appointment progress and allows fast tracking of urgent cases. There is also better communication between the referring physicians and rheumatologists. The triage system sends all missing tests, scans and x-rays to a central location for a faster and more efficient system of completing a patient’s file.

A second model discussed at the workshop was the Advanced Clinician Practitioner in Arthritis Care Program (ACPAC), and was presented by Kate Lundon, the Program Coordinator. Administered by the University of Toronto School of Medicine, the program targets physiotherapists and occupational therapists. It provides a comprehensive, advanced educational experience in rheumatology and orthopaedics so that these health care professionals gain a broader range of skills in their practice.

The program that started in 2005 will have 22 ACPAC trained practitioners by June 2008. The courses are given for one week every month, over ten months, enabling the practitioner to remain employed during the training. Over 60 faculty and multiple institutions are involved. The curriculum is a mix of formal academics and clinical education. There is a rigorous evaluation for both the trainees and the program. ACPAC is a Canadian Medical Education accredited program.

In the ACPAC program, students are assessed throughout courses and beyond. Twelve months after graduating it was found that the students had increased clinical responsibilities and used their skills to investigate and interpret clinical presentations and urgent red flag cases. They became educational leaders and mentors in arthritis care. The findings also revealed increased inter-professional care sharing in the clinical setting. Most importantly, however, was greater access to care for patients with arthritis, particularly in Northern Ontario where there is limited access to rheumatologists.

The new models demonstrate to provincial health policy makers who are struggling to contain health care costs while at the same time ensuring quality care within a system that has a deficit of health care professionals that solutions do exist.