Lee Jennifer J Y, Laxer Ronald M, Feldman Brian M, Barber Claire E H, Batthish Michelle, Berard Roberta, Tucker Lori B, Levy Deborah M
J.J.Y. Lee, MD, FRCPC, R.M. Laxer, MDCM, FRCPC, B.M. Feldman, MD, MSc, FRCPC, D.M. Levy, MD, MS, FRCPC, The Hospital for Sick Children (SickKids), and University of Toronto, Toronto, Ontario;
J.J.Y. Lee, MD, FRCPC, R.M. Laxer, MDCM, FRCPC, B.M. Feldman, MD, MSc, FRCPC, D.M. Levy, MD, MS, FRCPC, The Hospital for Sick Children (SickKids), and University of Toronto, Toronto, Ontario.
J Rheumatol. 2022 Feb;49(2):197-204. doi: 10.3899/jrheum.201611. Epub 2021 Aug 1.
To examine the Canadian pediatric rheumatology workforce and care processes.
Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic center provided workforce information including the number of providers, total and breakdown of full-time equivalents (FTEs), and triage processes. We calculated the clinical FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices.
The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centers. The median number of rheumatologists per center was 3 (IQR 3) and median cFTE was 1.9 (IQR 1.5). The median cFTE per 75,000 was 0.2 (IQR 0.3), with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit, but there was a regional maldistribution of rheumatologists. All centers engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤ 1. Most centers (87%) utilized a centralized triage process. Of 9 (60%) centers that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as previsit planning (67%), postvisit planning (68%), and periodic health outcome monitoring (36-59%).
This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
研究加拿大儿科风湿病医疗队伍及护理流程。
儿科风湿病学家和专职医疗专业人员（AHPs）参与研究。每个学术中心指定一人提供医疗队伍信息，包括医疗服务提供者数量、全职等效人员（FTEs）总数及分类，以及分诊流程。我们利用2019年人口普查数据计算每75,000名（推荐基准）和300,000名（调整后）儿童可获得的临床全职等效人员（cFTE）。国家医疗队伍缺口计算为当前和预期cFTE之间的差值。其余受访者被问及门诊实践情况。
调查A（医疗队伍信息）和调查B（门诊实践信息）的回复率分别为100%和54%。大多数风湿病学家（91%）在学术中心执业。每个中心风湿病学家的中位数为3（四分位间距3），cFTE中位数为1.9（四分位间距1.5）。每75,000人的cFTE中位数为0.2（四分位间距0.3），国家缺口为80个cFTE。按照调整后的基准，不存在国家缺口，但风湿病学家存在地区分布不均的情况。所有中心都开展多学科实践，不同AHP的中位数为4名，尽管AHP的FTE中位数≤1。大多数中心（87%）采用集中分诊流程。在使用电子分诊流程的9个（60%）中心中，6个能够计算等待时间。大多数临床医生采用了质量改进措施，如就诊前规划（67%）、就诊后规划（68%）和定期健康结果监测（36 - 59%）。
本研究证实按照当前推荐基准存在国家缺口。大多数风湿病学家在多学科团队中工作，但AHP的支持可能不足。
