Extended-role practitioners work to improve access to care for those living with joint pain

Arthritis is Canada’s most prevalent chronic health condition for which there is no cure. Early assessment and treatment is often the best approach to minimizing joint damage and decreasing the need for surgical interventions; however, wait times for patients to even get a diagnosis can take months – and in some cases years – all while the patient struggles to manage debilitating pain without any guidance or relief.

In 2015, Dr. Raja Rampersaud, Arthritis Program Spinal Surgeon at Toronto Western Hospital, as a result of philanthropic efforts, launched a pilot program designed to improve access for people suffering from back pain, reduce wait times and increase efficiencies within the healthcare system. Born out of an increasing frustration of seeing patients who have been waiting so long, only to advise that surgery was not the best approach to treating their pain, Dr. Rampersaud developed the Inter-professional Spine Assessment and Education Clinic (ISAEC), a new model of care in which patients and the primary care provider are supported by advance practice clinicians that provide rapid access assessment and individualized management plans.

Integral to the program are extended scope practitioners (ESP) specialised in assessing, triaging and managing patients with arthritis conditions who might benefit from alternative therapies before exploring surgery, where wait times can be lengthy. These roles – which include experienced physical therapists, occupational therapists, chiropractors and nurses – are immensely critical to the success of the program as they typically see new patients within a few weeks of a referral.

One such ESP is Leslie Soever, an Advanced Clinician Practitioner in Arthritis Care (ACPAC) and trained physiotherapist at Toronto Western Hospital. Leslie has completed specialised training in assessing and treating the shoulder, hip, knee, and spine. She believes the program’s success is a testament to true interprofessional collaboration.

“Ultimately, our collective goal is to improve patients’ access to, and quality of, care. We seek to optimize their outcomes by setting them up on the best treatment path for their specific condition,” says Leslie. “The key to being successful with this is through an enhanced interprofessional approach that allows us make connections quickly by working closely with our physician colleagues to collaborate and coordinate referrals and treatments as necessary.”

Extended scope practitioners also have more time to address specific patient questions, work with them one-on-one and educate them on the information and tools needed to help them manage their condition.

Julia Aubin, a patient of Dr. Rampersaud, is thrilled after just one appointment with Leslie. Diagnosed with spinal stenosis after a fall in her St. Catherine’s home in 2014, Mrs. Aubin has spent years managing her condition, which has resulted in periods of excruciating pain, parts of her left foot to become numb and the need to use therapeutic aids such as a walker or cane.

After moving to Toronto, Mrs. Aubin began seeing Dr. Rampersaud. Her annual appointment with Dr. Rampersaud serves as a as a check-in to gauge how her condition is progressing. However, on her most recent visit, Mrs. Aubin was introduced to Leslie for the first time.

“I immediately noted the format of my appointment was quite different from previous ones,” says Mrs. Aubin. “Leslie’s examination appeared to be extremely thorough. She spent substantial time to explore issues that were troubling me. After that, Leslie sat in on my appointment with Dr. Rampersaud making me feel as though I was truly supported by a team of experts who are focused on providing me with personalized care.”

Mrs. Aubin is not alone in her experience with the clinic. ISAEC patient surveys show that 99 per cent are satisfied with their consultations, 97 per cent are satisfied with their wait times and 94 per cent have a better understanding of their conditions. Overall, there is a reported reduced prevalence of unmanageable chronic lower back pain.

The ISAEC pilot also saw:

  • A 30 per cent plunge in MRI use.
  • Fewer unnecessary and costly referrals to spine surgeons and other specialists.
  • And a decrease in waits to see such specialists from as long as 18 months to as little as two weeks.

The success of the ISAEC pilot has been so positive that the Ministry of Health is in the process of rolling out rapid assessment clinics across the province, utilizing extended scope practitioners (called Advanced Practice Providers – APP) in interprofessional shared care models, focusing on a triage approach to providing better and faster care for patients with back pain.

However, back at Toronto Western Hospital, the team continues to push the boundaries to do all they can for patients, seeking new approaches that will enable even more positive outcomes. The need for additional patient educational tools is recognized and methods are being explored.

Further, philanthropic efforts are enabling the Arthritis Program to introduce the principles of ISAEC to include other joints, such as the shoulder, hips and knees, and eventually to foot and ankle. It is expected that interprofessional arthritis care, facilitated by ESPs will enable UHN to develop the arthritis clinic of the future now.

“We are proud of the success and the levels of patient satisfaction with the roll out of the rapid assessment clinics, but we are certainly not done,” says Leslie. “We know there is more to do to enable self-management and are exploring how we can improve means of patient education through exercise videos and e-learning modules to do more for Ontarians living with joint pain.”

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