+ bridging the rural-urban divide for patients with rheumatoid arthritis brenna bath school of...
TRANSCRIPT
![Page 1: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/1.jpg)
+
Bridging the rural-urban divide for patients with rheumatoid arthritis
Brenna BathSchool of Physical TherapyUniversity of Saskatchewan
![Page 2: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/2.jpg)
+Research Team/ Co-authors Dr. Regina Taylor-Gjevre, Professor, Rheumatologist (PI);
Dr. Bindu Nair, Associate Professor, Rheumatologist;
Dr. Samuel Stewart, Research Associate, Biostatistician;
Dr. Regan Arendse, Clinical Assistant Professor, Rheumatologist;
Dr. Latha Naik, Clinical Assistant Professor, Rheumatologist;
Dr. Catherine Trask, Assistant Professor;
Dr. Erika Penz, Assistant Professor;
Meenu Sharma, Research Assistant;
Katie Crockett, Clinical Research Associate
![Page 3: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/3.jpg)
+Outline
Background
Research objectives
Design and measures
Significance/ relevance
What have we learned so far?
Questions/ Discussion
![Page 4: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/4.jpg)
+Background
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting approximately 1% of the Canadian population.
Current standard of care includes use of disease modifying anti-rheumatic drugs and often biological agents, which require ongoing monitoring for toxicity and efficacy.
![Page 5: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/5.jpg)
+Background
People with RA often require regular rheumatology follow-up to ensure their disease is well-controlled and optimally treated.Up to a frequency of every 3 months Includes history and physical
examination.
This may lead to substantial travelling for RA patients who live in rural/remote regions.
![Page 6: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/6.jpg)
+Background
30% of Saskatchewan’s (SK) population lives in rural and remote regions
over 50% of RA patients attending a Saskatoon rheumatology clinic reside in health regions other than Saskatoon Health Region
36% of rheumatoid arthritis (RA) patients in SK consider location of their place of residence negatively impact ability to access health care
![Page 7: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/7.jpg)
+
*ALL SK Rheumatologists and 90% of PTs practice in urban centres
![Page 8: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/8.jpg)
+Our Challenge:How can we improve access to follow-up rheumatology care in rural SK communities?
1. Teams PTs travelling to rural communities to complete history/ “hands on” physical examination with rural RA patients
2. Technology Telehealth/ Videoconferencing to link to urban-based rheumatologist
![Page 9: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/9.jpg)
+Health Care Team
3 Rheumatologists
1 Nurse Educator
3 PTs travelling to clinics in 5 rural SK communities
![Page 10: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/10.jpg)
+
Rural Communities:Prince AlbertNorth BattlefordRosetownWynyard Arborfield
![Page 11: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/11.jpg)
+Technology: VIDYO (Secure VC)
![Page 12: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/12.jpg)
+Research Objectives
1) To determine whether disease-specific activity measures are equivalent for patients evaluated longitudinally by telehealth/VC compared to those seen in traditional rheumatology clinics over a nine-month period.
2) To evaluate quality-of-life and health-status measures as well as patient/healthcare provider levels of satisfaction for each care model.
![Page 13: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/13.jpg)
+Research Objectives
3) To determine incremental costs (direct and indirect) associated with distance telehealth/VC compared with traditional in-person rheumatology clinics.
4) To determine the validity/ accuracy of Rheumatologist/ PT team RA assessment through VC versus Rheumatologist in person.
![Page 14: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/14.jpg)
+Participants: RCT
160 patients living outside 100 km or more outside of Saskatoon, age over 18 years, and rheumatologist established diagnosis of RA will be recruited
Participants will be randomly assigned to one of two arms:1) followed by telehealth/VC in or near their home community 2) continue travelling to Saskatoon rheumatology clinic.
![Page 15: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/15.jpg)
RCT Design
![Page 16: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/16.jpg)
+RCT measures: Primary
DAS-28 CRP (at 9 months)Physical examination (swollen and
tender joint count)Examiner global score (100mm VAS)C-reactive Protein (CRP)
![Page 17: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/17.jpg)
+RCT measures: Secondary
Provider categorical assessment related to disease activity (inactive/stable; mildly active; very active)
Modified health assessment questionnaire (mHAQ)
RA disease activity index (RADAI)Quality of life (EQ5D)Cost diariesPatient satisfaction (VSQ-9)Patient and provider experience with VC/
telehealth (survey and interviews)
![Page 18: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/18.jpg)
+Validation study
Purpose to demonstrate that there is not a greater difference between disciplines than there is within disciplines for appendicular joint examination accuracy or for assessment of disease activity status.
50 participants with RA from Saskatoon region
![Page 19: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/19.jpg)
+Validation study
Each will be undergo physical examination (joint count) by 3 Rheumatologists and 3 PTs
The comparison groups will be:1. Rheumatologist A. to Rheumatologist B.2. Physiotherapist A. to Physiotherapist B.3. Rheumatologist A/B to Physiotherapist C/teleconferenced Rheumatologist C.
![Page 20: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/20.jpg)
+Significance/ Relevance
No previous reported studies of telehealth/VC based care for longitudinal rheumatologic follow up in RA patients
No reported studies utilizing interdisciplinary care teams in the telehealth/VC assessment process for this population.
![Page 21: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/21.jpg)
+Where is the project at?
Recruited approximately 50 patients for RCT
First VC team visits started in March 2015
Anticipate recruiting until September, 2015, with 9 month completion by June 2016
Validation study (Fall 2015)
![Page 22: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/22.jpg)
+What have we learned so far?
Technology: hardware, software, connectivity, support
Team:scope and collaborative practicescheduling
Recruitment:“near” home community“Costco” effect
![Page 23: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/23.jpg)
+Where to from here?
Combined experience and learning from this project and PT/ NP models for chronic low back pain
Mapping of primary care service (PT/ GP/ NP) to identify geographical care gaps
Rural and Remote musculoskeletal clinic Primary/ secondary interface careMultidisciplinary & InterprofessionalCombination of in-person and VC triage
or follow-up care
![Page 24: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/24.jpg)
+Acknowledgements
![Page 25: + Bridging the rural-urban divide for patients with rheumatoid arthritis Brenna Bath School of Physical Therapy University of Saskatchewan](https://reader030.vdocument.in/reader030/viewer/2022032722/56649ced5503460f949b979d/html5/thumbnails/25.jpg)
+Questions/ Discussion