Perceived barriers to integrated care in rheumatoid arthritis: views of recipients and providers of care in an inner-city setting.
BACKGROUND
A number of recent reports published in the UK have put the quality of care of adults with Rheumatoid Arthritis (RA) centre stage. These documents set high standards for health care professionals and commissioning bodies that need to be implemented into routine clinical practice. We therefore have obtained the views of recipients and providers of care in inner city settings as to what they perceive are the barriers to providing integrated care.


METHODS
We conducted focus groups and face to face interviews between 2005-8 with 79 participants (patients, carers, specialist medical and nursing outpatient staff and general practitioners (GPs)) working in or attending three hospitals and three primary care trusts (PCT).


RESULTS
Three barriers were identified that stood in the way of seamless integrated care in RA from the perspective of patients, carers, specialists and GPs: (i) early referral (e.g. 'gate keeper's role of GPs); (ii) limitations of ongoing care for established RA (e.g. lack of consultation time in secondary care) and (iii) management of acute flares (e.g. pressure on overbooked clinics).


CONCLUSIONS
This timely study of the multi-perspective views of recipients and providers of care was conducted during the time of publications of many important reports in the United Kingdom (UK) that highlighted key components in the provision of high quality care for adults with RA. To achieve seamless care across primary and secondary care requires organisational changes, greater personal and professional collaboration and GP education about RA.
Department of Rheumatology King's College London School of Medicine, London, UK. louise.pollard@kcl.ac.uk
Louise C
LC
Pollard
Helen
H
Graves
David L
DL
Scott
Gabrielle H
GH
Kingsley
Heidi
H
Lempp
D001172:Arthritis, Rheumatoid / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000458:organization & administration / Q000639:trends; D006282:Health Personnel / Q000458:organization & administration / Q000639:trends*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000458:organization & administration / Q000639:trends; D012017:Referral and Consultation / Q000458:organization & administration / Q000639:trends; D006113:United Kingdom; D019037:Urban Health Services / Q000458:organization & administration / Q000639:trends*; D014505:Urban Population / Q000639:trends*
J Clin Rheumatol. 2010 Sep;16(6):267-73
20689443
Aust Health Rev. 2009 Feb;33(1):93-9
19203338
BMJ. 2009 Feb 03;338:b183
19190015
Qual Health Res. 2005 Nov;15(9):1277-88
16204405
Rheumatology (Oxford). 2005 Apr;44(4):553-6
15728419
Rheumatology (Oxford). 2006 Dec;45(12):1522-8
16632478
Rheumatology (Oxford). 2000 Sep;39(9):939-49
10986297
Arthritis Rheum. 2006 Apr 15;55(2):300-5
16583428
J Adv Nurs. 2003 Jan;41(1):34-43
12519286
BMJ. 2008 Aug 07;337:a879
18687729
Clin Rheumatol. 2010 Jun;29(6):645-57
20127397
Ann Rheum Dis. 2010 Mar;69(3):503-9
19825849
Palliat Med. 2005 Jan;19(1):76-83
15690872
Rheumatology (Oxford). 2002 Oct;41(10):1208-10
12364653
BMJ. 2009 Oct 14;339:b4122
19828645
BMJ. 1995 Jul 22;311(6999):251-3
7627048
Diabet Med. 2001 Jul;18(7):554-7
11553184
Rheumatology (Oxford). 2010 May;49(5):1005-12
20189950
Med Care. 2009 Mar;47(3):350-5
19165120
Int J Qual Health Care. 2004 Feb;16(1):73-81
15020563