Skip to main content
Top
Published in: Human Resources for Health 1/2015

Open Access 01-12-2015 | Case study

Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

Authors: Esther Suter, Arden Birney, Paola Charland, Renee Misfeldt, Stephen Weiss, Jane Squire Howden, Jennifer Hendricks, Theresa Lupton, Deborah Marshall

Published in: Human Resources for Health | Issue 1/2015

Login to get access

Abstract

Introduction

This case study was part of a larger programme of research in Alberta that aims to develop an evidence-based model to optimize centralized intake province-wide to improve access to care. A centralized intake model places all referred patients on waiting lists based on severity and then directs them to the most appropriate provider or service. Our research focused on an in-depth assessment of two well-established models currently in place in Alberta to 1) enhance our understanding of the roles and responsibilities of staff in current intake processes, 2) identify workforce issues and opportunities within the current models, and 3) inform the potential use of alternative providers in the proposed centralized intake model.

Case description

Our case study included two centralized intake models in Alberta associated with three clinics. One model involved one clinic that focuses on rheumatoid disease. The other model involved two clinics that focus on osteoarthritis. We completed a document review and interviews with managers and staff from both models. Finally, we reviewed the scope of practice regulations for a range of health-care providers to examine their suitability to contribute to the centralized intake process of osteoarthritis and rheumatoid disease.

Discussion and evaluation

Interview findings from both models suggested a need for an electronic medical record and eReferral system to improve the efficiency of the current process and reduce staff workload. Staff interviewed also spoke of the need to have a permanent musculoskeletal screener available to streamline the intake process for osteoarthritis patients. Both models relied on registered nurses, medical office assistants, and physicians throughout their intake process. Our scope of practice review revealed that several providers have the competencies to screen, assess, and provide case management at different junctures in the centralized intake of patients with osteoarthritis and rheumatoid disease.

Conclusions

Using a broader range of providers in the centralized intake of osteoarthritis and rheumatoid disease has the potential to improve access and care specifically related to the assessment and management of patients. This may enhance the patient care experience and address current access issues.
Literature
3.
go back to reference Kaptein S, Gignac M, Badley E. Differences in the workforce experiences of women and men with arthritis disability: a population health perspective. Arthritis Rheuma (Arthritis Care Res). 2009;61:605–13.CrossRef Kaptein S, Gignac M, Badley E. Differences in the workforce experiences of women and men with arthritis disability: a population health perspective. Arthritis Rheuma (Arthritis Care Res). 2009;61:605–13.CrossRef
4.
go back to reference Li X, Gignac M, Anis A. The indirect costs of arthritis resulting from unemployment, reduced performance and occupational changes while at work. Med Care. 2006;44:304–10.CrossRefPubMed Li X, Gignac M, Anis A. The indirect costs of arthritis resulting from unemployment, reduced performance and occupational changes while at work. Med Care. 2006;44:304–10.CrossRefPubMed
5.
go back to reference Gillam MH, Lie SA, Salter A, Furnes O, Graves SE, Havelin LI, et al. The progression of end-stage osteoarthritis: analysis of data from the Australian and Norwegian joint replacement registries using a multi-state model. Osteoarthritis and Cartilage. 2013. doi:10.1016/joca.2012.12.008.PubMed Gillam MH, Lie SA, Salter A, Furnes O, Graves SE, Havelin LI, et al. The progression of end-stage osteoarthritis: analysis of data from the Australian and Norwegian joint replacement registries using a multi-state model. Osteoarthritis and Cartilage. 2013. doi:10.1016/joca.2012.12.008.PubMed
6.
go back to reference Vanderby SA, Carter MW, Noseworthy T, Marshall DA. Modeling the complete continuum of care using system dynamics: the case of osteoarthritis in Alberta. J Simul. 2015. doi:10.1057/jos.2014.43. Vanderby SA, Carter MW, Noseworthy T, Marshall DA. Modeling the complete continuum of care using system dynamics: the case of osteoarthritis in Alberta. J Simul. 2015. doi:10.1057/jos.2014.43.
7.
go back to reference Hanly J. Manpower in Canadian academic rheumatology units: current status and future trends. J Rheumatol. 2001;28:1944–51.PubMed Hanly J. Manpower in Canadian academic rheumatology units: current status and future trends. J Rheumatol. 2001;28:1944–51.PubMed
8.
go back to reference Badley EM, Davis AM. Meeting the challenge of the ageing of the population: issues in access to specialist care for arthritis. Best Practice Res Clin Rheumatol. 2012;26:599–609.CrossRef Badley EM, Davis AM. Meeting the challenge of the ageing of the population: issues in access to specialist care for arthritis. Best Practice Res Clin Rheumatol. 2012;26:599–609.CrossRef
9.
go back to reference Comeau P. Crisis in orthopedic care: surgeon and resource shortage. Can Med Assoc J. 2004;171:223.CrossRef Comeau P. Crisis in orthopedic care: surgeon and resource shortage. Can Med Assoc J. 2004;171:223.CrossRef
10.
go back to reference Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg. 2011;93:863–70.CrossRefPubMed Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg. 2011;93:863–70.CrossRefPubMed
11.
go back to reference Marshall D, Enns E, Vanderby S, Frank C, Wasylak T, Mosher D, et al. Estimating incidence and prevalence of osteoarthritis (OA) in Alberta using administrative claims data. Value Health. 2013;21(Suppl):S164. Marshall D, Enns E, Vanderby S, Frank C, Wasylak T, Mosher D, et al. Estimating incidence and prevalence of osteoarthritis (OA) in Alberta using administrative claims data. Value Health. 2013;21(Suppl):S164.
12.
go back to reference Hawker G, Bohm E, Connor-Spady B, De Coster C, Dunbar M, Hennigar A, et al. Perspectives of Canadian stakeholders on criteria for appropriateness for total joint arthroplasty in patients with hip and knee osteoarthritis. Arthritis & Rheumatology. 2015; In press. Hawker G, Bohm E, Connor-Spady B, De Coster C, Dunbar M, Hennigar A, et al. Perspectives of Canadian stakeholders on criteria for appropriateness for total joint arthroplasty in patients with hip and knee osteoarthritis. Arthritis & Rheumatology. 2015; In press.
13.
go back to reference Li LC, Badley EM, MacKay C, Mosher D, Jamal S, Jones A, et al. An evidence-informed, integrated framework for rheumatoid arthritis care. Arthritis Rheuma. 2008;59:1171–83.CrossRef Li LC, Badley EM, MacKay C, Mosher D, Jamal S, Jones A, et al. An evidence-informed, integrated framework for rheumatoid arthritis care. Arthritis Rheuma. 2008;59:1171–83.CrossRef
14.
go back to reference Doerr C, Graves S, Mercer G, Osborne R. Implementation of a quality care management system for patients with arthritis of the hip and knee. Aust Health Rev. 2013;37:88–92.CrossRefPubMed Doerr C, Graves S, Mercer G, Osborne R. Implementation of a quality care management system for patients with arthritis of the hip and knee. Aust Health Rev. 2013;37:88–92.CrossRefPubMed
15.
go back to reference Chao J, Kalunian K. Managing osteoarthritis. A multidisciplinary approach. J Musculoskelet Med. 2010;27:1–8. Chao J, Kalunian K. Managing osteoarthritis. A multidisciplinary approach. J Musculoskelet Med. 2010;27:1–8.
16.
go back to reference Choy E, Scott D, Kingsley G, Williams P, Wojtulewski J, Papasavvas G, et al. Treating rheumatoid arthritis early with disease modifying drugs reduces joint damage: a randomised double blind trial of sulphasalzaine vs diclofenac sodium. Clin Exp Rheumatol. 2002;20:351–8.PubMed Choy E, Scott D, Kingsley G, Williams P, Wojtulewski J, Papasavvas G, et al. Treating rheumatoid arthritis early with disease modifying drugs reduces joint damage: a randomised double blind trial of sulphasalzaine vs diclofenac sodium. Clin Exp Rheumatol. 2002;20:351–8.PubMed
17.
go back to reference Villaneuve E, Nam JL, Bell MJ, Deighton CM, Felson DT, Hazes JM, et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis. 2014;72:13–22.CrossRef Villaneuve E, Nam JL, Bell MJ, Deighton CM, Felson DT, Hazes JM, et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis. 2014;72:13–22.CrossRef
18.
go back to reference Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology. 2013;52:99–110.CrossRefPubMed Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology. 2013;52:99–110.CrossRefPubMed
19.
go back to reference Marshall DA, Burgos-Liz L, Maarten JI, Osgood ND, Padula WV, Higashi MK, et al. Applying dynamic simulation modeling methods in health care delivery research – the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force. Value Health. 2015;18:5–16.CrossRefPubMed Marshall DA, Burgos-Liz L, Maarten JI, Osgood ND, Padula WV, Higashi MK, et al. Applying dynamic simulation modeling methods in health care delivery research – the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force. Value Health. 2015;18:5–16.CrossRefPubMed
20.
go back to reference Maddison P, Jones J, Breslin A, Barton C, Fleur J, Lewis R, et al. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. Br Med J. 2004;329:1325–7.CrossRef Maddison P, Jones J, Breslin A, Barton C, Fleur J, Lewis R, et al. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. Br Med J. 2004;329:1325–7.CrossRef
21.
go back to reference Bichel A, Erfle S, Wiebe V, Axelrod D, Conly J. Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Quar. 2009;13:61–8.CrossRef Bichel A, Erfle S, Wiebe V, Axelrod D, Conly J. Improving patient access to medical services: preventing the patient from being lost in translation. Healthc Quar. 2009;13:61–8.CrossRef
22.
go back to reference Frank C, Marshal D, Faris P, Smith C. Essay for the CIHR/CMAJ Award: improving access to hip and knee replacement and its quality by adopting a new model of care in Alberta. Can Med Assoc J. 2011. doi:10.1503/cmaj.110358. Frank C, Marshal D, Faris P, Smith C. Essay for the CIHR/CMAJ Award: improving access to hip and knee replacement and its quality by adopting a new model of care in Alberta. Can Med Assoc J. 2011. doi:10.1503/cmaj.110358.
23.
go back to reference Crabtree BF, Miller WL. Researching practice settings: a case study approach. In: Crabtree BF, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999. p. 293–312. Crabtree BF, Miller WL. Researching practice settings: a case study approach. In: Crabtree BF, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999. p. 293–312.
24.
go back to reference Yin RK. The case study anthology. Thousand Oaks, CA: Sage Publications; 2006. Yin RK. The case study anthology. Thousand Oaks, CA: Sage Publications; 2006.
25.
go back to reference Patton MQ. Qualitative evaluation and research methods. 2nd ed. Newbury Park: Sage Publications; 1990. Patton MQ. Qualitative evaluation and research methods. 2nd ed. Newbury Park: Sage Publications; 1990.
26.
go back to reference Tongco D. Purposive sampling as a tool for informant selection. Ethnobotany Res Appl. 2007;5:147–58.CrossRef Tongco D. Purposive sampling as a tool for informant selection. Ethnobotany Res Appl. 2007;5:147–58.CrossRef
27.
go back to reference Crabtree BF, Miller WL. Sampling in qualitative inquiry. In: Crabtree BF, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999. p. 33–46. Crabtree BF, Miller WL. Sampling in qualitative inquiry. In: Crabtree BF, Miller WL, editors. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications; 1999. p. 33–46.
28.
go back to reference Thomas D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27:237–46.CrossRef Thomas D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27:237–46.CrossRef
35.
go back to reference Kur J, Koehler B. Rheumatologist demographics in British Columbia: a looming crisis. Br Columbia Med J. 2011;53:128–31. Kur J, Koehler B. Rheumatologist demographics in British Columbia: a looming crisis. Br Columbia Med J. 2011;53:128–31.
36.
go back to reference Speed CA, Crisp AJ. Referrals to hospital-based rheumatology and orthopaedic services: seeking direction. Rheumatology. 2005;44:469–71.CrossRefPubMed Speed CA, Crisp AJ. Referrals to hospital-based rheumatology and orthopaedic services: seeking direction. Rheumatology. 2005;44:469–71.CrossRefPubMed
37.
go back to reference MacKay C, Veinot P, Badley E. Characteristics of evolving models of care for arthritis: a key informant study. BMC Health Serv Res. 2008;8:146–56.CrossRef MacKay C, Veinot P, Badley E. Characteristics of evolving models of care for arthritis: a key informant study. BMC Health Serv Res. 2008;8:146–56.CrossRef
39.
go back to reference Solomon DH, Bitton A, Fraenkel L, Brown E, Tsao P, Katz JN. Roles of nurse practitioners and physicians assistants in rheumatology practices in the US. Arthritis Care Res. 2014;66:1108–13.CrossRef Solomon DH, Bitton A, Fraenkel L, Brown E, Tsao P, Katz JN. Roles of nurse practitioners and physicians assistants in rheumatology practices in the US. Arthritis Care Res. 2014;66:1108–13.CrossRef
41.
go back to reference Marion C, Balfe L. Potential advantages in interprofessional care in rheumatoid arthritis. J Manag Care Pharm. 2011;17(Suppl B):S25–9.PubMed Marion C, Balfe L. Potential advantages in interprofessional care in rheumatoid arthritis. J Manag Care Pharm. 2011;17(Suppl B):S25–9.PubMed
42.
go back to reference Walker J. Rheumatoid arthritis: role of the nurse and multidisciplinary team. Br J Nurs. 2012;21:334–9.CrossRefPubMed Walker J. Rheumatoid arthritis: role of the nurse and multidisciplinary team. Br J Nurs. 2012;21:334–9.CrossRefPubMed
43.
go back to reference Lundon K, Shupak R, Reeves S, Schneider R, McIlroy JH. The advanced clinician practitioner in arthritis care program: an interprofessional model for transfer of knowledge for advanced practice practitioners. J Interprof Care. 2009;23:198–200.CrossRefPubMed Lundon K, Shupak R, Reeves S, Schneider R, McIlroy JH. The advanced clinician practitioner in arthritis care program: an interprofessional model for transfer of knowledge for advanced practice practitioners. J Interprof Care. 2009;23:198–200.CrossRefPubMed
Metadata
Title
Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study
Authors
Esther Suter
Arden Birney
Paola Charland
Renee Misfeldt
Stephen Weiss
Jane Squire Howden
Jennifer Hendricks
Theresa Lupton
Deborah Marshall
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2015
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-015-0033-3

Other articles of this Issue 1/2015

Human Resources for Health 1/2015 Go to the issue