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
Sleep disturbances are reported in up to 80% of persons with inflammatory arthritis (IA) and are poorly addressed. Cognitive-behavioral therapy for insomnia (CBTi) is the first-line insomnia treatment in the general population, but access is limited. Internet-delivered CBT for insomnia (ICBTi) overcomes accessibility barriers. A randomized waitlist-controlled pilot trial was conducted to determine the acceptability and preliminary efficacy of ICBTi for individuals with inflammatory arthritis and insomnia symptoms.
Participants with IA and symptoms of insomnia were recruited through social media and patient-partner organizations and randomly assigned to the ICBTi treatment group (n= 24; 6 modules over 8 weeks) or the waitlist-control group (n= 26). Participants completed surveys at baseline, 8 weeks (post-treatment), and 3 months later. Treatment group participants completed questions about treatment perceptions. The Insomnia Severity Index (ISI) (maximum score of 28) assessed insomnia symptoms at each time point. Paired sample t-tests were used to analyze changes in ISI scores over time for each group.
The sample included 50 participants with IA and insomnia symptoms (Table 1). Post treatment completion, most participants in the treatment group rated the ICBTi modules as moderately or extremely useful (84%) and were moderately or extremely satisfied (89%) with the program. Seventy-three percent of treatment group participants self-reported moderate or extreme improvements in sleep. However, only 52% of the treatment group completed the entire program. Feedback included wanting more relevance to arthritis and chronic pain, and a guide alongside the intervention. The mean baseline ISI score was 16.7 in the treatment group and 14.9 in the control group. Twenty treatment groups and 24 control group participants completed the 8-week survey. The mean (95% CI) change in ISI scores pre- to post-treatment in the treatment group was −4.95 (−6.77, −3.13), p<.001, and −0.94 (−.38, 2.26) in the control group, a non-significant difference. Eighteen treatment group and 21 control group participants completed the 3-month survey. The mean (95% CI) change in ISI scores from pre-treatment to the 3-month follow-up was −5.28 (−7.62, −2.93, p<.001) in the treatment group and −0.83 (−1.53, 3.20) in the control group, a non-significant difference.
Table 1
Characteristics of the Sample
The Internet-delivered CBTi program was acceptable and perceived as useful by most participants but could benefit from further adaptation to arthritis-specific needs. The results suggest efficacy of ICBTi among individuals with arthritis. A larger randomized-controlled trial with a larger, more diverse sample is needed to determine the effectiveness of using ICBTi to help people manage the double-burden of insomnia and arthritis.
Supported by a CIORA grant
Emilie McGuire, Nicole J. Andersen, Josée Savard et al.· Journal of Rheumatology· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
