The roles of nurse practitioners and physician assistants in rheumatology practices in the US (original) (raw)
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Addressing the Rheumatology Workforce Shortage: A Question of Supply and Demand
The Journal of Rheumatology
The combination of a growing and aging population and advances in treatment have increased demands for rheumatology services across the world. In the United States, a shrinking rheumatology workforce, driven by retirements and a shift toward part-time work, coupled with this increased demand, has led to estimates that the demand for rheumatology clinical providers will outstrip supply by over 100% by 2030.1
ACR open rheumatology, 2022
Objective. The study objective was to assess adherence to system-level performance measures measuring retention in rheumatology care and disease modifying anti-rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Methods. We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow-up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care. Results. The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow-up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care. Conclusion. System-level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow-up is needed. This study was supported by ICES (formerly known as the Institute for Clinical Evaluative Sciences) which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by the
Open Access Rheumatology: Research and Reviews
To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods: We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the "Treat-to-Target" strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results: We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4-6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion: The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
Use of general practice and rheumatology outpatient services in rheumatoid arthritis
Family Practice, 2012
Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rheumatologists and following treatment guidelines. In this study, we analyse the utilization of health care among patients with RA and explain the determinants of the frequency of use of GP and rheumatologist services. A random sample (n = 1259) of adult Estonian patients with RA was investigated in 2007. A pre-structured questionnaire included questions regarding respondents&amp;amp;amp;#39; socio-economic status, quality of life, self-reported use of health care, time, distance and financial aspects of access to health care. The impact of the variables on the frequency of use of health care was analysed with regression analysis. Use of GP services was higher among people who lived outside the capital, had more health problems and experienced disability due to their RA. Time and distance limits had an effect on the frequency of use of both primary and specialist care. A shorter waiting time to the GP and a longer waiting time to the rheumatologist were associated with more frequent use of GP services, but a shorter waiting time to the rheumatologist was related to more frequent visits to the rheumatologist. Patient&amp;amp;amp;#39;s costs were not associated with the frequency of health care use. Use of health care among people with RA depends primarily upon doctors&amp;amp;amp;#39; waiting times, patients&amp;amp;amp;#39; place of residence and their health status. The GP has a significant role in the management of RA patients, especially for those who have multiple health problems and those living in rural areas.
BMC rheumatology, 2022
Objective: To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. Methods: We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. Results: Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67-1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83-0.97). These trends persisted after adjusting for other covariates.
Arthritis & Rheumatism, 2012
Purpose-To examine prescribing of biologic and nonbiologic disease-modifying anti-rheumatic drugs (nbDMARDs) in Rheumatoid Arthritis (RA) before and after publication of the American College of Rheumatology (ACR) treatment recommendations. Methods-We identified biologic naïve RA patients cared for by US rheumatologists participating in the CORRONA registry with visits prior to and/or at least 6 months after publication of the ACR recommendations (time periods: 2/02-6/08 vs. 12/08-12/09). The population was divided into two mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users; and 2) multiple nbDMARD users. Initiation or dose escalation of biologic and nbDMARDs in response to active disease was assessed cross-sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was compared using logistic regression stratified by disease activity adjusting for clustering of physicians and geographic region. Results-After one visit, 24 to 37% of MTX monotherapy users with moderate disease activity and poor prognosis or high disease activity received care consistent with the recommendations; it was 34 to 56% after 2 visits. In the multiple nbDMARD users, 30 to 47% of those with moderate or high disease activity received care consistent with the recommendation after one visit and 43 to 51% after 2 visits. Publication of the recommendations did not significantly change treatment patterns for active disease. Conclusions-Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary.
Exploring a national practice-based register for the management of rheumatoid arthritis
year: 2008, 2008
The bottom line is that -we, as physicians, owe it to society to assess and reduce the under-care and over-care and medical errors that are contributing to the healthcare cost crisis -we, as physicians, owe it to our patients to provide more effective, cost-efficient care by making optimal use of current information and technology, and -we, as rheumatologists, are best positioned to chart the course and guide improvement in the care of rheumatic and musculoskeletal diseases
The United States rheumatology workforce: Supply and demand, 2005–2025
Arthritis & Rheumatism, 2007
Methods. A supply model was developed using the age and sex distribution of current physicians, retirement and mortality rates, the number of fellowship slots and fill rates, and practice patterns of rheumatologists. A Markov projection model was used to project needs in 5-year increments from 2005 to 2025. Results. The number of rheumatologists for adult patients in the US in 2005 is 4,946. Male and female rheumatologists are equally distributed up to age 44; above age 44, men predominate. The percent of women in adult rheumatology is projected to increase from 30.2% in 2005 to 43.6% in 2025. The mean number of visits per rheumatologist per year is 3,758 for male rheumatologists and 2,800 for female rheumatologists. Assuming rheumatology supply and demand are in equilibrium in 2005, the demand for rheumatologists in 2025 is projected to exceed supply by 2,576 adult and 33 pediatric rheumatologists. The primary factors in the excess demand are an aging population which will
Nurse-led Care and Patients as Partners Are Essential Aspects of the Future of Rheumatology Care
The Journal of Rheumatology, 2017
Living with chronic inflammatory arthritis (CIA), such as rheumatoid arthritis (RA) or spondyloarthritis (SpA), affects not only patients' physical functioning but also emotional, psychological, and social aspects that have a global effect on their life situation as a whole 1. The multidisciplinary team is important for the rheumatology care of patients with CIA, which should be delivered with an awareness of the patients' whole life situation. The team should enable these patients to care for themselves and retain or regain optimum independence. The various professional categories in the team have distinct roles but collaborate to focus on the patients' resources and needs 2. Recommendations for rheumatology nursing management of CIA from the European League Against Rheumatism state that rheumatology nurses should participate in comprehensive disease management to control disease activity, as well as in identifying, assessing, and addressing psychosocial issues. This work is a valuable complement to the medical care and helps lower healthcare costs. For patients to achieve a greater sense of control, self-efficacy and empowerment, the nurse should meet the patient's expressed needs and promote self-management skills 3. Rheumatology research has completely changed the therapeutic arena over the past 2 decades, generating the development of the biological disease-modifying antirheumatic drugs (bDMARD) for a greater number of indications 4. Despite this advance, research on nurse-led rheumatology care (NLC) has predominantly focused on patients with RA and conventional DMARD. A systematic review, including 4 randomized controlled trials (RCT) from 1994 to 2006, revealed in a metaanalysis (n = 431) that NLC compared to rheumatologist-led care (RLC) added value by improving patients' perceived quality of life and knowledge, and lessening fatigue. While patient-reported outcomes such as functional status, satisfaction, pain, stiffness, and coping with arthritis favored NLC, there was insufficient evidence to draw conclusions 5 .