Shared-care rheumatology clinic with virtual visits ‘successful by many metrics’
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Key takeaways:
- A shared-care clinic with virtual visits was “a viable strategy” to address a widening care gap in rural Ontario.
- The model led to an estimated $276,428 in total travel savings for all patients over 9 years.
A shared-care rheumatology clinic, where a rheumatologist saw patients virtually after another health care professional performed an initial assessment, was “successful by many metrics” and led to travel cost savings, according to a study.
“Inflammatory arthritis affects patient health outcomes, productivity and quality of life, with societal and system-level reverberations,” Amanda J. Steiman, MD, MSc, FRCP, a rheumatologist at Mount Sinai Hospital, in Toronto, and colleagues wrote in The Journal of Rheumatology. “Access disparities widen the care gap for patients living in rural-remote communities. Populations living in Ontario in regions with decreased access to primary care practitioners also have limited access to rheumatology care.”
To assess an alternative care strategy, Steiman and colleagues conducted a retrospective, descriptive, observational single-cohort study of an Ontario-based, shared-care virtual clinic. They examined data from 124 patients (mean age at first visit, 55.6 years) seen from the program’s creation in January 2013 to January 2022.
Patients in the program were initially assessed in-person by a health care professional certified through Canada’s Advanced Clinician Practitioner in Arthritis Care program, also referred to as the extended-role practitioner (ACPAC-ERP). The ACPAC-ERP recorded health history, performed a physical exam, and scheduled necessary laboratory and imaging tests ahead of the patient presenting to the rheumatologist via telehealth.
The researchers described the program as having a “hub-and-spoke” design, with the “spoke” being the ACPAC-ERP located 465 km (289 miles) away from the rheumatologist working remotely at the “hub” site, St. Michael’s Hospital in Toronto.
To analyze the model’s performance, Steiman and colleagues examined the times between each step in the care process for all patients assessed by the ACPAC-ERP as having suspected inflammatory arthritis or connective tissue disease. They also estimated travel cost savings using “calculations of hypothetical distances” between patients’ regional postal codes and St. Michael’s Hospital.
Overall, diagnoses of inflammatory arthritis or connective tissue disease were confirmed in 65% of patients. The mean time from primary care referral to assessment by the ACPAC-ERP was 52.5 days, with a further 64.5 days mean time from assessment to telerheumatology visit.
The researchers estimated that the program helped to avoid 493,470 km (306,628 miles) of patient-related travel, leading to $276,428 in cost savings.
“The described hub-and-spoke telerheumatology shared-care model was successful by many metrics and thus reflects a viable strategy to address this widening care gap,” Steiman and colleagues wrote. “Expanding and sustaining this model of care with continued generation and fiscal support of highly trained ACPAC-ERPs would provide improved local access to rheumatology care to patients living in rural-remote Ontario.”
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