Physicians specially trained in rheumatology expanding access to care

561

Arthritis is a disease of the musculoskeletal system that involves inflammation of one or more joints and consists of more than 100 kinds of different conditions with many different causes. Some forms of arthritis affect children, while hundred of thousands of people will be affected in the prime of their lives.

According to The 2000 Canadian Community Health Survey (CCHS), arthritis and other rheumatic conditions affected nearly four million Canadians aged 15 years and older – approximately one in six. Two-thirds of those with arthritis were women, and nearly three out of every five people with arthritis were younger than 65 years of age. By 2026, it is estimated that over six million Canadians 15 years of age and older will have arthritis.

Given the short supply of rheumatologists in Canada, and the decline in enrolment in rheumatology residency programs, hurdles that limit access to specialty services, including lack of locally available services and low rate of referral by primary care physicians, need to be addressed.

The importance of early intervention and diagnosis “ExpertMD(tm) in Rheumatology”, a specially designed training program for family practitioners, hopes to reduce the shortage of resources in rheumatology. A faculty of Canadian rheumatologists and family practitioners partnered with Dr. Denis Choquette of Conceptmed Inc. acting as National Chair, the instructional design department of the University of Alberta and the superb support of Merck Frosst Company Canada and its e-CHE department to set up Canada’s first formalized training program in rheumatology utilizing an innovative blended learning educational approach.

The program establishes a mid-level team of family physicians with advanced training in musculoskeletal disorders intended to improve access for patients to rheumatological care in Canada. This will help family physicians to better diagnose and treat common rheumatological conditions, understand when to refer to specialists and, where skill and interest allow, act as resources to their peers in the delivery of enhanced rheumatological care in their communities. Two hundred and fifty (250) family physicians have started an extensive program of 150 hours over an 18-month period that will conclude at the end of 2004.

Role of the primary care physician The first comprehensive report (The Report) on arthritis published in 2003 by Health Canada and the Arthritis Community Research and Evaluation Unit (ACREU) showed that individuals with arthritis tend to make contact with their health-care providers in a greater proportion than people with other health chronic conditions. In fact, 82 per cent of patients who made visits for arthritis and related conditions, made at least one of these visit to a primary care physician.

The role of this primary care physician is particularly significant in rural and remote areas of Canada where access to specialist care is not readily available. Well-trained physicians participating in ExpertMD(tm) will play a central role and become more proactive in providing optimal care for people with arthritis and related conditions by helping their patients get an early diagnosis.

Complex treatment regiment to treat arthritic diseases

There is no cure for inflammatory arthritis. Treatment involves a wide variety of medications aimed at relieving pain, preserving joint function and limiting the progression of the disease by reducing inflammation. Arthritis can lead to joint destruction that could result in long-term disability. Newer and safer treatment options have been discovered that can effectively treat the pain and inflammation caused by arthritis with fewer side effects for patients.

ExpertMD(tm) in Rheumatology curriculum includes training on how to initiate appropriate treatment of common rheumatological conditions. The actual university curriculum for first line physicians training in any MSK conditions is on average ten days duration. Such a short training is completely inadequate considering that arthritis of all sorts is the second cause for consultation in family practice. Diagnosis of MSK disorders is based on effective questionnaire and joint examination. Tests and imagery techniques will not replace the basic skills of physicians. In fact they may be the source of significant confusion. A positive test for rheumatoid arthritis does not mean that you have the disease. We still too frequently receive, as rheumatologist, such inappropriate consult requests.

A flexible CME program based on ‘blended learning’ ExpertMD(tm) offers a blended learning program which means that instruction will be delivered via a mix of instructional methods including face-to-face meetings, preceptorships, Internet-based learning modules and traditional communication technologies. The adoption of adult learning principles, reflective practice and case-study approaches have been combined to create a unique environment to improve physicians’ knowledge which has been shown to encourage positive changes in their practice.

We know from previous research that effective education will lead to changes in the way people do things. The traditional way of teaching via large group lectures with an expert speaker is a very expensive way to disseminate new medical information. But it is also very ineffective as retention of knowledge is very low. Learning styles vary from one person to the other. Using different strategies such as in ExpertMD(tm) will improve long-term retention of newly acquired skills and knowledge because it addresses these different way of learning. ExpertMD(tm) will certainly be more effective at producing changes in practice patterns.

This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited for 25.0 MAINPRO-C credits. For more information please contact Dr. Choquette at dchoquette1@hotmail.com.