title: Commonalities and differences in the implementation of models of care for arthritis: key informant interviews from Canada.
abstract: Timely access to effective treatments for arthritis is a priority at national, provincial and regional levels in Canada due to population aging coupled with limited health human resources. Models of care for arthritis are being implemented across the country but mainly in local contexts, not from an evidence-informed policy or framework. The purpose of this study is to examine existing models of care for arthritis in Canada at the local level in order to identify commonalities and differences in their implementation that could point to important considerations for health policy and service delivery.
  
  
  
  Semi-structured key informant interviews were conducted with 70 program managers and/or care providers in three Canadian provinces identified through purposive and snowball sampling followed by more detailed examination of 6 models of care (two per province). Interviews were transcribed verbatim and analyzed thematically using a qualitative descriptive approach.
  
  
  
  Two broad models of care were identified for Total Joint Replacement and Inflammatory Arthritis. Commonalities included lack of complete and appropriate referrals from primary care physicians and lack of health human resources to meet local demands. Strategies included standardized referrals and centralized intake and triage using non-specialist health care professionals. Differences included the nature of the care and follow-up, the role of the specialist, and location of service delivery.
  
  
  
  Current models of care are mainly focused on Total Joint Replacement and Inflammatory Arthritis. Given the increasing prevalence of arthritis and that published data report only a small proportion of current service delivery is specialist care; provision of timely, appropriate care requires development, implementation and evaluation of models of care across the continuum of care.
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada. cheryl.cott@utoronto.ca.|Arthritis Community Research & Evaluation Unit and Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada. cheryl.cott@utoronto.ca.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Cott
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.|Arthritis Community Research & Evaluation Unit and Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada.|Institutes of Health Policy, Management and Evaluation and Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Arthritis Community Research & Evaluation Unit and Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada.|Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.affiliation: Arthritis Community Research & Evaluation Unit and Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Wong
authors.affiliation: Arthritis Community Research & Evaluation Unit and Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada.
authors.forename: Mayilee
authors.initials: M
authors.lastname: Canizares
authors.affiliation: Department of Physical Therapy, Department of Medicine, University of British Columbia and Arthritis Centre of Canada, Vancouver, BC, Canada.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Li
authors.affiliation: Department of Physical Therapy, Faculty of Rehabilitation Medicine and School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Allyson
authors.initials: A
authors.lastname: Jones
authors.affiliation: Ontario Division of The Arthritis Society, Toronto, ON, Canada.
authors.forename: Sydney
authors.initials: S
authors.lastname: Brooks
authors.affiliation: Ontario Rheumatology Association, Toronto, Canada.
authors.forename: Vandana
authors.initials: V
authors.lastname: Ahlwalia
authors.affiliation: Women's College Hospital and the University of Toronto, Toronto, ON, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Jaglal
authors.affiliation: Doctor of Physical Therapy Division, Department of Community and Family Medicine, Duke University Medical Centre, Durham, NC, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Landry
authors.affiliation: Health Care and Outcomes Research, Toronto Western Research Institute, University of Toronto, Toronto, ON, Canada.
authors.forename: Crystal
authors.initials: C
authors.lastname: MacKay
authors.affiliation: Arthritis Alliance Canada, Vancouver, BC, Canada.
authors.forename: Dianne
authors.initials: D
authors.lastname: Mosher
mesh_terms: D001168:Arthritis / Q000628:therapy*; D019643:Arthroplasty, Replacement; D002170:Canada; D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008962:Models, Theoretical; D012017:Referral and Consultation; D014218:Triage
keywords: Arthritis; Models of care; Total joint replacement