A change for the better: Southlake’s Arthritis Program develops new model of care

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Granted Ministry funding in 1991, The Arthritis Program (T.A.P.) at Southlake Regional Health Centre has developed into a leader in its field in the way it delivers care to patients. A team committed to pushing the envelope, they are currently involved in a project looking at improving access to primary care for patients with new onset arthritis.

“We saw a way that we thought could get patients into a treatment program faster which would mean giving them the tools they needed to deal with their condition and improve their overall quality of life sooner,” said Ieva Fraser, Program Coordinator

Located 40 minutes north of Toronto the program’s two year project received a grant from The Change Foundation that has allowed the interdisciplinary team to establish a pre-diagnosis clinic for individuals who are exhibiting symptoms of rheumatoid arthritis (RA).

As RA and its related disorders can cause irreparable damage to joints, muscles and other body systems, research has shown that early diagnosis is crucial. There are approximately 150 rheumatologists in Ontario with a population of 12 million. One in seven adults develop one of the 135 types of arthritis. The majority of patients diagnosed with RA and related disorders are between their twenties and fifties: prime work and child rearing years and current waiting lists are more than eight months long.

Traditionally patients are referred to the rheumatologist first for diagnosis and medication recommendations and then referred for rehabilitative care. On average, 95 per cent of the diagnostic process for RA relies on the history and physical exam. The pre-diagnostic clinic at Southlake utilized rheumatology-trained occupational therapists to obtain the patient’s medical history, conduct a physical examination and order delegated pre-determined tests, such as x-rays and blood work.

“This has been an extremely rewarding project to be involved with. It has allowed the occupational therapists full use of our scope of practice. The response from our patients has been positive and they are benefiting from this new process,” said Lorna Bain, Occupational Therapist.

As damage can occur within six months from the time of symptom onset, enabling skilled therapists to perform these essential investigations allows rheumatologists to reduce their many month waiting lists and dedicate their expertise to diagnosing and initiating treatment plans for their patients. Once diagnosed, patients can then be referred to Southlake’s existing Arthritis Program to receive comprehensive care on how to manage their disease, including self-management and use of appropriate medication.

“This is an excellent clinic. It saves the rheumatologist time and allows the patient to be seen sooner. From the time my referring physician initiated my arthritis care, to being assessed, was only six weeks,” said Maryna Pastoor, clinic patient.

A total of 228 patients have been part of the research project. The data collection ended March 31, 2005 with the final data and report to be completed by October 2005, culminating in a Master’s thesis by a student from the University of Toronto.

Ieva Fraser said, “Preliminary data tells us that this clinic is a success for our patients. The approach, we believe, will also prove to save the health care system money by using qualified therapists to their fullest potential, allowing rheumatologists to focus their time on diagnosis and treatment.”

“The outcome for people with RA is dependent on two factors within the control of the Early Arthritis Clinic: early assessment and treatment and appropriate prescription to completely control the disease process. This program has mean earlier access to diagnosis and care for the patient with the new onset of RA, thus optimizing outcome for patients,” Dr. C. Thorne, M.D and TAP program rheumatologist.

Fast facts

  • 135 types of arthritis
  • majority of people with the condition are women
  • TAP receives 2,000 patient referrals each year
  • 15,000 patient attendances each year