An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

Vandana Ahluwalia,1 Taucha Inrig,2 Tiffany Larsen,3 Rachel Shupak,4 Tripti Papneja,1 Arthur Karasik,5 Carol Kennedy,2 Katie Lundon6 1Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada; 2Musculoskeletal Health and Outcomes Research, St. Michael’s Hospital, Toronto, ON, Canada; 3Department of Physiotherapy, Headwaters Healthcare Centre, Orangeville, ON, Canada; 4Division of Rheumatology, Department of Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada; 5Independent Rheumatology Practice, Etobicoke, ON, Canada; 6Continuing Professional Development, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaCorrespondence: Vandana AhluwaliaIndependent Community Rheumatology Practice, 314-40 Finchgate Boulevard, Brampton, ON, Canada, L6T 3J1 Tel +1 905-799-1850 Ext 221Fax +1 905-799-8040Email a7mad.al0rabi@gmail.comPurpose: This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices.Materials and Methods: Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period.Results: Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model.Conclusion: The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.Keywords: health service accessibility, interprofessional practice, rheumatology, patient satisfaction, quality improvement, extended role practitioner, integrated delivery systems, model of care