title: Optimal care for rheumatoid arthritis: a focus group study.
abstract: Our study sought to identify barriers to optimal care for individuals with rheumatoid arthritis (RA). Our study was set in a population with universal access to comprehensive health care in the context of a university hospital health network. Using purposive sampling, we invited RA patients, health professionals, and decision makers from urban and rural regions to participate in structured focus group interviews. Content analysis was performed to determine themes emerging from the data. We identified four general themes. First, initial barriers to optimal care for people begin before primary care contact, at the level of the general population and/or related to primary care access. Second, many factors (at the patient, physician, and system level) influenced how quickly a patient is referred from primary to specialty care. Third, after referral, multiple comanagement issues influence patient outcomes. Fourth, optimizing RA care requires adequate resources. Participants emphasized the need for more education (of patients, of health care providers, and within the general community), better communication between and among patients and health care providers, and more efficient use of existing resources. Our work provides insights regarding barriers to and facilitators of optimal care in RA. Further work with these stakeholder groups in our health care region will examine potential solutions and the feasibility of their implementation. Our work provides an example of how research can assist stakeholder leaders in creating structured and incremental plans to improve health care delivery for persons with chronic diseases like RA.
authors.affiliation: Division of Rheumatology, McGill University Health Centre (MUHC), Montreal, QC, Canada. Sasha.bernatsky@mail.mcgill.ca
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.forename: Debbie
authors.initials: D
authors.lastname: Feldman
authors.forename: Mirella
authors.initials: M
authors.lastname: De Civita
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.forename: Pierre
authors.initials: P
authors.lastname: Tousignant
authors.forename: Jean
authors.initials: J
authors.lastname: Legaré
authors.forename: Michel
authors.initials: M
authors.lastname: Zummer
authors.forename: Tim
authors.initials: T
authors.lastname: Meagher
authors.forename: Christopher
authors.initials: C
authors.lastname: Mill
authors.forename: Mark
authors.initials: M
authors.lastname: Roper
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lee
mesh_terms: D001172:Arthritis, Rheumatoid / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research