Supporting Equity in Rheumatoid Arthritis Outcomes in Canada: Population-specific Factors in Patient-centered Care.

Autor:	Pianarosa E; E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto., Hazlewood GS; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada., Thomas M; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta., Hsiao R; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada., Barnabe C; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada.
Jazyk:	angličtina
Zdroj:	The Journal of rheumatology [J Rheumatol] 2021 Dec; Vol. 48 (12), pp. 1793-1802. Date of Electronic Publication: 2021 May 15.
DOI:	10.3899/jrheum.210016
Abstrakt:	Objective: Health equity considerations have not been incorporated into prior Canadian Rheumatology Association guidelines. Our objective was to identify the challenges and possible solutions to mitigate threats to health equity in rheumatoid arthritis (RA) care in Canada. Methods: A consultation process informed selection of priority populations, determined to be rural and remote, Indigenous, elderly with frailty, first-generation immigrant and refugee, low income and vulnerably housed, and diverse gender and sex populations. Semistructured interviews were completed with patients with lived experience, healthcare providers, and equity-oriented researchers. These interviews probed on population factors, initial and ongoing healthcare access issues, and therapeutic considerations influencing RA care. Known or proposed solutions to mitigate inequities during implementation of service models for the population group were requested. The research team used a phenomenological thematic analysis model and mapped the data into a logic model. Solutions applicable to several population groups were proposed. Results: Thirty-five interviews were completed to identify realities for each population in accessing RA care. Five themes emerged as primary solutions to population-based inequities, including actively improving the patient-practitioner relationship, increasing accessibility and coordination of care through alternative models of care, upholding autonomy in treatment selection while actively addressing logistical barriers and individualized therapy needs, collaborating with health supports valued by the patient, and being advocates for policy change and health system restructuring to ensure appropriate resource redistribution. Conclusion: The challenges for populations facing inequities in rheumatology care and promising solutions should inform guideline development and implementation, policy change, and health system restructuring. (Copyright © 2021 by the Journal of Rheumatology.)
Databáze:	MEDLINE
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