Considering that increasing prevalence of arthritis is expected to outpace the number of specialists available to treat the condition, primary care physicians would do well to consider the experiences and advice of leaders of national Canadian arthritis study groups.
During the 1990s, the Arthritis Society (AS) recognized a growing problem with regard to proper care of arthritis sufferers in the primary care setting in Canada. Despite some 9 million physician visits per year in Canada, physicians were having difficulty identifying and diagnosing arthritis and in turn delayed referral to specialists, and overall admitted a lack of confidence in their ability to treat these conditions.
In response, AS pilot tested a physician education program called “Getting a Grip on Arthritis” in Ontario in 2000, and based on its success, implemented the program nationally between the years 2004 and 2006.
On the heels of the program’s completion, Dr. Lucie Brosseau of the University of Ottawa began a similar project entitled “People Getting a Grip on Arthritis,” but whereas Getting a Grip on Arthritis focused on physician education, People Getting a Grip on Arthrtis dealt with the education of patients with rheumatoid and osteoarthritis.
The experience gained from implementation of these two projects is important when considering the US population and the increasing prevalence of arthritis that is expected to accompany its aging. The number of specialists available to treat them is not expected to keep pace, and therefore treatment will fall to the primary care setting.
Clinicians would do well to consider the following experiences and advice of program leaders:
It is especially important to emphasize the advocacy role for allied health professionals in areas such as specialist referral and pharmacological interventions.
Culturally appropriate interventions should be devised for both native and military populations.
The workshops did improve recommendations for best practices, but success depended on discipline and especially the model of care (community health center, physician network, regional model, federal network) in which they worked.
A large part of the success of the initiative depended on compensating physicians in some way for their time. “There were no costs to the physicians for the workshop, and travel expenses were covered,” says Sydney Lineker, PhD, MSc, BScPT, of the Arthritis Society. “While there was no compensation for lost clinical time, we tried to hold the sessions when providers wanted in order to avoid a loss of their time.”
Dr. Brosseau found that during follow up the project had fewer responders than the study population because questionnaires were too long and patients didn’t feel like going through the entire thing. Streamline your follow-up process so that it is simple for patients while retaining its effectiveness as a research tool.
One especially interesting thing to consider is the time of year in which the educational efforts are made. On follow up, many patients indicated to Brosseau that they were not keeping up with their physical therapy because the activities were difficult to perform in winter. While educational efforts should be made whenever possible, reinforcement should occur especially during good weather months in order that patients are better able to establish an ongoing exercise routine.
Seasonal concerns aside, fostering motivation overall is key, according to Brosseau. “Confidence [among patients] immediately after a workshop was high, but three months later it had diminished."
Lineker admits that the national campaign was not carried out as efficiently as the pilot study and stresses that efforts to educate physicians must be a collaborative effort across geographic and professional lines. “If we could do it again,” she says, “we would involve arthritis representatives in each province, where they know which patients are trained. We ran the national program in isolation to some extent, and you need buy in or nothing will come of i
And finally, Lineker stresses resource allocation. The Getting a Grip on Arthritis program is still running in Ontario, but without the post-workshop reinforcement efforts for physicians. “We were surprised that it made no difference in outcomes, so we only do it if people ask for the support. And then we’ll only do that if communities are willing to host it and help get local funding.” Figure out what doesn’t work, then allocate those resources to further improve things that do.