To improve the delivery and outcomes of inflammatory arthritis (IA) care in Canada, we are co-designing FlexCAre in partnership with adults living with IA and arthritis health care providers (HCPs). FlexCAre aims to provide flexible delivery of care to better meet the individual needs of patients and achieve better health outcomes. This study reports findings from focus groups conducted with Canadian IA HCPs to explore their experiences, values, and preferences regarding the timing, modality, and nature of IA healthcare visits.
Structured online 90-minute focus groups were conducted with HCPs using a predefined question guide to explore opportunities to optimize IA care delivery. Transcripts were thematically coded and analyzed to identify patterns to inform new approaches, interventions, and policy.
The 30 HCPs had a mean (SD) age of 64 (13) years. They included rheumatology nurses (67%), rheumatologists (30%) and pharmacists (3%) in BC (60%) and AB (40%) who had been practicing on average 16 years. Three overarching themes were identified: (1) The challenge of whole person care. HCPs noted that when patients lack access to primary care, providing whole person care can feel overwhelming and limits their ability to focus on complex, dynamic disease-specific needs. Equity gaps are greatest among older adults, racialized groups, individuals with mobility limitations, and in rural areas. Unrealistic patient expectations regarding the scope of services rheumatologists can offer were noted, particularly when patients lack a family doctor and/or mental health services. (2) The need for education and support from IA interprofessionals. Sustaining interprofessional teams remains challenging, even with provincial funding. HCPs emphasized the value of rheumatology team members to educate patients and fill gaps by providing virtual visits, responding to messaging systems, and returning calls. (3) Individualizing care through flexible tools and strategies. HCPs varied in their use of and preferences for virtual care and between-visit monitoring, and tailoring approaches to patient needs, disease status, and life context. Flexibility regarding visit scheduling, type, and monitoring was deemed essential. Several noted that when medication approval depends on symptom assessments, patients are more likely to complete questionnaires. E-health systems can provide disease education and self-management skills training.
HCPs identified key challenges and opportunities to improve IA care delivery. Findings underscore the importance of flexible, integrated, and patient-centered approaches to meet diverse needs, support whole person care, and reduce the burden on providers and meet patient needs. These insights are helping inform the co-design of FlexCAre.
Nadia Deville-Stoetzel, Emilie McGuire, Kayli Raptis et al.· Journal of Rheumatology· 0 citations
We explored the barriers and facilitators of participating in the patient-initiated follow-up strategy Appointments By Choice (ABC) from the perspectives of participating patients with rheumatoid arthritis (RA).
Patients enrolled in the ABC pilot were invited via email to participate in semi-structured qualitative interviews. Patients were selected from 2 different time points: mid-study (6 months) and end-of-study (12 months), post-enrollment. Demographic information was collected at study enrollment through an online survey hosted on Qualtrics. Interviews were conducted using Zoom Videoconferencing and were 1 hour in length. Interview transcripts were independently analyzed thematically and in duplicate using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to ABC participation.[1] Coders met regularly to address additional themes as they emerged from the transcripts, to discuss and modify codes, and reconcile differences. Interviews ceased once saturation was met. Ten CFIR codes representing key domains (Implementation process, individual, inner setting, innovation, and innovation outcomes) were applied deductively, and 5 additional codes were introduced inductively to capture emergent themes.
Ten participants (5 mid-study, 5 end-of-study) were interviewed. The median age was 61 years (IQR = 13.75), and participants had lived with RA for a median of 11.5 years (IQR = 13). Four out of the 10 participants identified as White/European, and 6 out of the 10 participants identified as female. Reported barriers included uncertainty about whom to contact in the event of a flare or other rheumatologic concern, and challenges maintaining regular lab testing when in-person follow-up reminders were absent. Other barriers included missing the physician/patient relationship and the social visit aspect of the rheumatology clinic appointment. Facilitators included shared decision-making with rheumatologists, the availability of a flare action plan promoting self-management,[2] and the use of a self-reported flare questionnaire,[3] as ongoing “check-ins”. Patients valued the flexibility of the ABC model, particularly those living at a distance, and highlighted the responsiveness of the flare clinic and pharmacist support in medication adjustments. An unexpected facilitator was patients’ altruistic motivation, awareness of clinic workload and willingness to defer appointments to allow others with greater needs to be seen sooner. Select domains and patient quotes are displayed (Table 1).
Table 1.
Selected Barriers and Facilitators to ABC Participation (as Highlighted in Abstract), with Representative Quotes Mapped to CFIR Domains
People with RA described ABC as a feasible and acceptable model of care, with minimal barriers identified. Addressing clarity around flare management and lab testing will improve patient experience and willingness to participate in this patient-initiated follow-up model.
[1.] Damschroder LJ. Implement Sci 2022;17:75. [2.] Ester M. BMC Rheumatol 2025;9:31. [3.] Bartlett SJ. J Rheumatol 2017;44:1536-43.
Supported by a CIORA grant
Kiran Dhiman, M. Ester, Krista White et al.· Journal of Rheumatology· 0 citations
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