Study Explores Multidisciplinary Care for Patients with Inflammatory Arthritis

Investigators called for the development of health care system structures to better support the exchanging of resources and information.

A recent phenomenological study explored the experiences of people with inflammatory arthritis (IA) and their health care networks to gain a broader understanding of how those effected perceived access to multidisciplinary care.

The data gathered in the study suggested the development of health care system structures to support the flow of information and resource transfer was needed to promote network collaboration and equitable access to resources.

Investigators led by Catherine L. Backman, PhD, The University of British Colombia, noted that many patients with IA have not received timely and appropriate multidisciplinary care that is considered a standard care pathway for this patient population.

Backman and colleagues employed a social network lens to explore factors such as network structures and processes that governed patient access to timely and appropriate multidisciplinary health care.

The Methods

A total of 14 patient participants and 19 health care network members comprised of health care providers and informal caregivers were interviewed for the study.

Participants were recruited from metropolitan Vancouver, British Colombia, Canada using a 2-phased purposive sampling process that included recruitment through local arthritis clinics and social media platforms.

Backman and colleagues established 2 research questions for the study: How do people with IA and their health care network members perceive access to multidisciplinary IA care, and what health care network structures and processes influence timely and appropriate access to IA care?

Additionally, semi-structured, in-depth interviews were conducted on each participant, each typically lasting 20 to 60 minutes.

Interview questions focused on participant perceptions of patient experiences with diagnosis, interactions with their health care team, and support managing IA.

From there, data were coded to describe phenomena around how participants perceived access to multidisciplinary IA care, with NVivo 11 being used to help organize data.

A 3-stage iterative process involving item analysis, pattern analysis, and structural analysis was used for the study.

The Findings

Backman and colleagues defined the overarching theme of the holistic IA care, with 2 broad, multifaceted subthemes: connected networks and whole person care, and network disconnect and disrupted access to care.

Investigators wrote that the first subtheme noted how access to health care provider and social support was fundamental to holistic care, and how care was facilitated by communication pathways that promoted care.

Several patients spoke of the importance of being geographically close to their health care providers, while others felt the consistency of care and comfortable relationships with health care providers was of primary importance.

Regarding the second sub-theme, all patients had experienced disrupted access to holistic care, with patients reporting difficulties finding new primary care physicians due to a variety of factors including physician retirement, practice closure, patient relocation, and a general lack of support for referral for tests or specialist consultation.

Access to rehabilitation resources was inconsistent throughout the study, and access to the most effective pharmacological therapy was also disrupted.

Overall, the findings of the study suggested that the goal of holistic patient care was shared by all participants, with network communication and resource transfer potentially governing access to care.

“We propose the development of several organizational structures to support communication and resource transfer, which promote reachability and collaboration. This multi- layered network approach may facilitate more equitable access to whole person multidisciplinary care for people with IA,” the team wrote.

The study, “Networks of Care: A Social Network Perspective of Distributed Multidisciplinary Care for People With Inflammatory Arthritis,” was published online in the European Journal of Rheumatology.