Characteristics of evolving models of care for arthritis: a key informant study.
BACKGROUND
The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a) examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b) document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis.


METHODS
Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care.


RESULTS
Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1) Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists) in expanded clinical roles: 2) triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3) ongoing management in collaboration with a specialist. Two models promoting rural access were 4) rural consultation support and 5) telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients.


CONCLUSIONS
A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary care.
MacKay
Crystal
C
Arthritis Community Research and Evaluation Unit (ACREU), Toronto Western Research Institute, Toronto, Ontario, Canada. cmackay@uhnres.utoronto.ca
Veinot
Paula
P
Badley
Elizabeth M
EM
D001168:Arthritis / Q000628:therapy*; D003191:Comprehensive Health Care; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team; D012017:Referral and Consultation; D014218:Triage