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November 16, 2023
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PCP training improves rheumatoid arthritis care in underserved Native American populations

Fact checked byShenaz Bagha
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SAN DIEGO — A 12-week, remote training program improved rheumatoid arthritis knowledge and clinical behaviors among PCPs in underserved Native American populations across the United States, according to speaker at ACR Convergence 2023.

“The seeds of this work really began with the rheumatology workforce shortage,” Jennifer Mandal, MD, of the University of California, San Francisco, told attendees. “We hear a lot about the fact that there is a critical shortage of rheumatology providers in the United States. What we do not talk about as much is just how inequitably those rheumatologists are distributed.”

Doctor-patient communication
“We hear a lot about the fact that there is a critical shortage of rheumatology providers in the United States,” Jennifer Mandal, MD, told attendees. “What we do not talk about as much is just how inequitably those rheumatologists are distributed.” Image: Adobe Stock

This is particularly true of Native American populations. According to Mandal, the prevalence of RA within the Navajo Nation is five times that of the general U.S. population. Meanwhile, wait times to see the single rheumatologist serving the reservation and its surrounding area can extend up to 6 months.

In 2021, the Rheumatology Access Expansion Initiative launched the Rheumatoid Arthritis (RA) ECHO, a remote 12-week training program to instruct primary care providers serving the Navajo Nation in diagnosing and managing RA.

“The mission of the initiative is to expand access to rheumatology care for underserved communities with a particular focus on Native American communities,” Mandal said.

After successful deployment of the program in exclusively Navajo populations in 2021 and 2022, the group expanded it for a fourth cohort to other Native American communities nationwide in 2023. Health care workers serving Native American communities all across the country were invited to participate.

In the current study, Mandal and colleagues assessed the impact on knowledge, confidence and clinical behaviors pertaining to RA in 93 health care providers who participated in one of the four RA ECHO program cohorts. The final analysis included data for 32 providers who had paired pre- and post-intervention scores for knowledge and confidence surrounding RA management.

According to the researchers, test scores for RA knowledge improved by 26% (95% CI, 19-33), and confidence improved by 1.08 points (95% CI, 0.75-1.41) on the Likert scale. Both of these results were statistically significant, the researchers wrote. In addition, 79% of participants reported performing “desirable clinical behaviors” associated with RA diagnosis and management either “more frequently” or “much more frequently” after completing the program.

“They were doing a full joint exam or making sure their patients were up to date on their vaccines after completing the course,” Mandal said.

Importantly, although the first three cohorts of participants in the program were mainly primary care providers, the fourth cohort was much more “inter-professional,” according to Mandal.

“We found, in particular, that there was a lot of interest among community health representatives taking this course,” she said.

According to Mandal, the success of this program has led the group to consider new initiatives in Native American populations and expand training to other disease states like spondyloarthritis.

“For now, we are continuing with RA ECHO,” Mandal said. “We are in our fifth cohort.”