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Biln, Norma Kor

University of British Columbia

Background: There are two broad types of arthritis, and patient care differs by type. Those with inflammatory arthritis (IA) should be treated by a rheumatologist within 12 weeks of symptom onset, while those with non-IA, can benefit from multi-disciplinary care and lifestyle modifications. No standard referral tools are used to help primary care physicians (PCP) direct people with joint pain to the appropriate healthcare provider. Many patients wait needlessly, sometimes in the wrong queue, increasing their chances of disability. Objectives: First, to understand recent trends in patient referrals to rheumatologists in British Columbia (BC). Second, to identify and test the accuracy of a patient-completed questionnaire to classify and prioritize patients with IA for referral from primary care to rheumatologists and seek the perspectives of patients and rheumatologists for implementation considerations. Methods: Using administrative databases from Population Data BC, current rheumatology referrals trends were examined. A scoping review was performed to identify validated questionnaire(s) to evaluate in a BC clinical study: The Patient Self-Administered Inflammatory Arthritis Detection (SAID) study. A multi- and mixed methods approach was used to gain user perspectives of barriers and opportunities to implement a questionnaire in the referral pathway. Results: Rheumatology referral trends in BC showed long wait times for patients with IA and a high proportion of referral of patients with non-IA. Access improved between 2010-2020 but remained long, particularly for females and people living outside of metropolitan areas. The scoping review identified 53 studies of referral tools. Two tools were selected for The Patient SAID Study; the Early Inflammatory Arthritis Questionnaire (EIAQ) and the Case Finding Axial Spondyloarthritis (CaFaSpa) questionnaire. The reported EIAQ performance was not replicated, but a new, preliminary scoring algorithm, that added a back pain question, had promising performance (AUC=0.740, 95%CI 0.632-0.849) suggesting that EIAQ questions were informative. Patients and rheumatologists supported the use of the questionnaire for referrals and provided recommendations for clinical implementation. Conclusions: There is a need to improve the rheumatology referral process in BC and this thesis tested a patient-completed questionnaire that may support that. The findings suggest the potential value of the questionnaire to streamline referrals and access to care.

Text

2024-08-06

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88878

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/