Training program for PCPs improves rheumatoid arthritis care for Navajo patients
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PHILADELPHIA — A novel program offering rheumatoid arthritis training for primary care providers in the Navajo Nation improved treatment access, according to data presented at ACR Convergence 2022.
“We also found that primary care providers on Navajo Nation are frequently managing rheumatologic conditions with little or no specialist input, because they simply have to,” Jennifer Mandal, MD, an assistant professor of medicine at the University of California, San Francisco, said during a press conference. “They are the ones who are on the front lines to provide this care.”
The Navajo Nation, which is the largest American Indian reservation in the United States, has just a single rheumatologist serving 250,000 tribal members, according to Mandal. As a result, most RA care has fallen to primary care providers on the reservation, who often do not feel confident prescribing RA medications or managing the disease, she added.
To address this RA care gap, Mandal and colleagues developed a training program for primary care providers in the Navajo Nation. Prior to developing a plan of action, researchers conducted a needs assessment. Following the assessment, a team of rheumatologists, a pharmacist and Navajo cultural interpreters met and developed a 12-week course for the treatment of RA. This course included weekly interactive webinars that featured didactic and case discussions.
A total of 18 primary care providers — including 15 physicians, one nurse practitioner, one physician associate and one community health worker — enrolled in the course and completed surveys before and after participating. The survey included an RA medical test as well as questions asking physicians to self-report their confidence in RA identification and management. Questions assessing confidence were part of three sections, including diagnosis, management with conventional disease-modifying antirheumatic drugs, and biologics. Knowledge questions additionally assessed diagnosis and management. Meanwhile, the survey following completion asked physicians to rate the usefulness of each portion of the course.
In all, 10 primary care providers completed the confidence survey, nine completed the knowledge tests and 17 completed the satisfaction survey. Post-training confidence survey scores were significantly higher than scores from pre-training surveys in all groups (P < .05), with biologic management confidence increasing the most. In addition, knowledge test scores rose by 22% (95% CI, 10% to 34%). Average section usefulness was graded at 4.52 out of 5.
“We are really proud that this curriculum seems to be a very effective way to improve PCPs’ knowledge and confidence when it comes to managing RA,” Mandal said. “We are excited to continue this work and we are currently in the midst of our third cohort of PCPs who are taking the course in Navajo Nation.”
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Mandal J. Abstract 0005. Presented at: ACR Convergence 2022; Nov. 11-14, 2021; Philadelphia (hybrid meeting).
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