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Evaluating the impact on access of the introduction of nurse-supported care for people with complex rheumatic diseases in British Columbia Duncan, Ross

Abstract

Background A 2010 workforce survey revealed British Columbia was facing a shortage of rheumatologists and a consequent crisis of access to rheumatology care. Rheumatic diseases are chronic, and early intervention is crucial to prevent progression and mitigate systemic damage. Recognizing nurses may be able to perform aspects of rheumatology care and thereby “free up” rheumatologist time, the Ministry of Health introduced billing code G31060 to facilitate nurse-supported consultations for the “complex” rheumatology cases most in need of attention. The objective of this thesis is to evaluate the impact of introducing this new billing code and model of care on access to rheumatology care for the population of BC living with rheumatic disease. Methods I conducted an interrupted time series analysis with a comparator using administrative health data on outpatient visits from Population Data BC. Patients with rheumatic diseases were identified using International Classification of Diseases codes and classified as those who received the intervention (i.e. nurse-supported rheumatologist care) or ‘status quo’ (i.e. rheumatologist care alone). Access was defined as 1) number of unique patients treated per month 2) number of service units billed per month. In sensitivity analyses I explored the impact of more restrictive definitions of intervention which required more “consistent” (at least once in every year) and “high-intensity” (at least 30 per year) billing of G31060. Results The primary cohort included 128,726 patients with rheumatic disease, seen by 29 intervention and 17 comparator rheumatologists. No statistically significant effect change in level or trend of unique patients (pβ6=0.682 & pβ7=0.231) or service units (pβ6=0.744 & pβ7=0.419) attributable to the introduction of G31060 was detected in the primary analysis. Sensitivity analyses revealed statistically significant, increases in patients seen for rheumatologists billing “consistently” (62%) and with “high intensity” (168%) in April 2015 as compared to ‘status quo’. Conclusion The introduction of G31060 does not appear to impact the number of service units billed per month, nor does it necessarily increase the number of patients seen. However, consistent and high-intensity users of G31060 appear to increase the number of unique patients seen per month.  

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