Addressing the Challenges of Chronic Disease Management in a Resource-Constrained Health System: The Role of Nurse-Led Shared Care Models for Patients with Rheumatoid Arthritis

Background:The limited capacity of and increasing demand in care created two major challenges in addressing the needs of patients with Rheumatoid arthritis (RA): i) long waiting times for new patients; and, ii) unmet standards of care for patients with stable disease. Nurse-led care (NLC) models are one proposed approach to improving access to and quality of care.Objectives:The objectives were to i) compare the quality of care for patients with stable RA in the NLC and rheumatologist-led care (RLC) models; ii) estimate the resource utilization and costs in patients followed in those models; and, iii) explore effects of the implementation of NLC clinics for the follow-up of patients with stable RA on the capacity for the delivery of care for patients with a confirmed or suspected diagnosis of RA, who had been referred to and followed at a single academic rheumatology center, as compared to RLC only.Methods:Three studies were conducted: i) a non-inferiority retrospective cohort study with a review of clinical charts; ii) an analysis of the utilization of physician visits; emergency department visits; hospital admissions, and disease-modifying anti-rheumatic drugs using linked chart review and health administrative data and a costing analysis; and iii) discrete event simulation (DES) modeling.Results:Compared to the RLC model, the NLC model provided at least as effective disease monitoring for patients with stable RA and offered better documentation of comorbidity screening and provision of patient education. The NLC follow-up was not associated with increases in healthcare resource utilization or cost as compared to the RLC follow-up. The DES model’s Base Case representing the practice of a rheumatologist in an academic center after the implementation of NLC clinics showed higher numbers of appointments offered and new patients accepted, and lower waiting times for new urgent and moderate/routine patients as compared to a scenario with no NLC clinics available.Conclusions:The NLC model for patients with stable RA was an effective strategy to address patients’ needs for ongoing disease monitoring, chronic disease management, education, support, and increase health system capacity.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor

Cumming School of Medicine

Year dc:date.issued

2021

Author dc:creator

• Lopatina, Elena

Advisors dc:contributor.advisor

• Marshall Deborah A
• Barber Claire EH

Committee members dc:contributor.committeemember

• LeClercq Sharon A
• Noseworthy Tom W
• Suter Esther

• Health Economics
• Health System Capacity
• Quality of Care

Language dc:language.iso

English

DOI

https://dx.doi.org/10.11575/PRISM/dspace/41191

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/116347