Fullerton Laura M, Brooks Sydney, Sweezie Raquel, Ahluwalia Vandana, Bombardier Claire, Gagliardi Anna R
Ontario Best Practices Research Initiative, Toronto General Research Institute, Toronto, ON, Canada.
Ontario Division, Arthritis Society, Toronto, ON, Canada.
Pragmat Obs Res. 2020 Jan 28;11:1-12. doi: 10.2147/POR.S213966. eCollection 2020.
The objective of this qualitative study was to explore patient, rheumatologist, and extended role practitioner (ERP) perspectives on the integration of an allied health rheumatology triage (AHRT) intervention in Ontario rheumatology clinics. Triage is the process of identifying the urgency of a patient's condition to ensure they receive specialist care within an appropriate length of time. This research explores the clinical/logistical impact of triage by occupational and physical therapists with advanced arthritis training (ERPs), including facilitators and barriers of success, and recommendations for future application.
Semi-structured telephone interviews were held with participating rheumatologists, ERPs, and a sample of patients from each clinical site (4 community, 3 hospital) in five Ontario cities. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using basic qualitative description. Two independent researchers compared coding and achieved consensus.
Patients (n=10), rheumatologists (n=6), and ERPs (n=5) participated in the study and reported reduced wait-times to rheumatology care, diagnosis, and treatment for those with inflammatory arthritis (IA). Rheumatologists and ERPs perceived that the intervention improved clinical efficiency and quality of care. Patients reported high satisfaction with ERP assessments, valuing early joint examination/laboratory tests, urgent referral if needed, and the provision of information, support, and management strategies. Facilitators of success included: supportive clinical staff, regular communication and collaboration between rheumatologist and ERP, and sufficient clinical space. Recommendations included extending ERP roles to include stable patient follow-up, and ERP care between scheduled rheumatology appointments.
Findings support the integration of ERPs in a triage role in the community and hospital-based rheumatology models of care. Future research is needed to explore the impact of utilizing ERPs for stable patient follow-up in rheumatology settings.
本定性研究的目的是探讨患者、风湿病学家以及扩展角色从业者（ERP）对于安大略省风湿病诊所采用联合健康风湿病分诊（AHRT）干预措施的看法。分诊是确定患者病情紧急程度的过程，以确保他们在适当时间内获得专科护理。本研究探讨了接受过晚期关节炎培训的职业治疗师和物理治疗师（ERPs）进行分诊的临床/后勤影响，包括成功的促进因素和障碍，以及对未来应用的建议。
对安大略省五个城市的参与研究的风湿病学家、ERPs以及每个临床地点（4个社区诊所、3家医院）的患者样本进行了半结构化电话访谈。访谈进行了录音并逐字转录。使用基本定性描述对转录文本进行分析。两名独立研究人员对编码进行比较并达成共识。
患者（n = 10）、风湿病学家（n = 6）和ERPs（n = 5）参与了研究，报告称炎症性关节炎（IA）患者接受风湿病护理、诊断和治疗的等待时间缩短。风湿病学家和ERPs认为该干预措施提高了临床效率和护理质量。患者对ERP评估高度满意，重视早期关节检查/实验室检查、必要时的紧急转诊以及信息、支持和管理策略的提供。成功的促进因素包括：支持性的临床工作人员、风湿病学家和ERP之间的定期沟通与协作以及充足的临床空间。建议包括扩大ERP的职责范围，以包括对稳定患者的随访以及在预定的风湿病预约之间提供ERP护理。
研究结果支持将ERPs纳入社区和医院风湿病护理模式的分诊角色。未来需要进行研究，以探讨在风湿病环境中利用ERPs进行稳定患者随访的影响。
