Effectiveness of an Outreach Model of Care for Rheumatology Specialty Clinics to an On-Reserve First Nations Community
| Autor: | Cheryl Barnabe, Marvin J. Fritzler, Tyler White, Brenda R. Hemmelgarn, Sujay Nagaraj, Margaret Kargard |
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| Rok vydání: | 2018 |
| Předmět: |
030203 arthritis & rheumatology
medicine.medical_specialty business.industry Inflammatory arthritis Rheumatology specialty Disease Primary care medicine.disease Disease activity Outreach 03 medical and health sciences 0302 clinical medicine Rheumatoid arthritis Physical therapy medicine 030212 general & internal medicine Longitudinal cohort business |
| Zdroj: | International Journal of Indigenous Health. 13:157-167 |
| ISSN: | 2291-9376 2291-9368 |
| DOI: | 10.32799/ijih.v13i1.30315 |
| Popis: | A model of care consisting of rheumatology specialty services embedded in the primary care system on a First Nations reserve was instituted to reduce barriers to care and improve inflammatory arthritis outcomes for patients. We assessed the effectiveness of this model of care on disease activity measures and patient-reported outcomes over 7 years. Patients were enrolled in a longitudinal cohort at the Siksika Nation in Alberta. Clinical characteristics, treatment recommendations and disease activity measures were systematically recorded over follow-up. Mixed-model regression was performed to determine rates of change for continuous measures. 59 participants (78% female; M = 47 years, SD = 13), predominantly with rheumatoid arthritis (RA; n = 36), were followed for an average of 29 months (SD = 23). Swollen and tender joint counts decreased significantly (change per month: -0.20, 95% CI -0.29 to -0.10, and -0.20, 95%CI -0.34 to -0.06, respectively) but pain, physician global and function scores did not significantly improve (all p > 0.05). Patient global evaluation scores worsened over time (change per month 0.08, 95%CI 0.029 to 0.131, p = 0.002). Inflammatory markers improved at a slower rate in patients with incident compared to incident disease. Disease-modifying agents were escalated for moderate or high disease activity at 64% of RA visits, with justifications for not escalating or application of local treatment approaches in all but one instance. Despite improvement in swollen and tender joint counts and adherence to current treatment paradigms, patient-reported outcomes did not significantly improve during follow-up. Further innovation is required to meet relevant outcomes. |
| Databáze: | OpenAIRE |
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