One-on-one Education for Family Doctors Improves Care for Rheumatoid Arthritis

 

Principal Investigator:

Diane Lacaille, MD, MHSc, FRCPC
Mary Pack Chair in Arthritis Research
Senior Research Scientist, Arthritis Research Canada
Professor, University of British Columbia

 

Why do this research?

The last 10-15 years have seen a radical shift in the way rheumatoid arthritis (RA) is treated. Treatment guidelines for RA now recommend early, aggressive and persistent use of disease modifying anti-rheumatic drugs (DMARDs) in all people with active inflammation. This has been shown to prevent permanent joint damage and reduce the risk of work disability and premature death.

Our research and that of others has shown that people with RA are not receiving the care they need. Despite DMARDs being considered essential for the treatment of RA, many individuals with RA have never been prescribed DMARDs (only 43% had received a DMARD over a 5 year period). People are more likely to be treated with DMARDs if they see a rheumatologist during the course of their disease, however many individuals are never referred to a rheumatologist. If they are referred, waitlists are often long and long distance travel is often necessary, especially if they come from rural communities.

Our results suggest that family physicians, as the first point of contact for early RA, need to be informed of the recent paradigm shift in the treatment of RA. Studies have shown that dissemination of guidelines through the traditional channels is not effective at modifying practice patterns of family physicians.

The objective of this study was to develop and evaluate the effectiveness of an educational intervention specifically targeted at family physicians to inform them of the recent changes in the way RA is treated and provide them with tools to help them implement current treatment guidelines.

 

What has been found?

We have provided academic detailing to family physicians in Burnaby, North Vancouver, Coquitlam, Port Coquitlam and New Westminster. Surveys and interviews show that family physicians find this a convenient and efficient way to receive medical education about rheumatoid arthritis. They rated the educational value of the visits highly and indicated they intended to make changes to their practice as a result of the visit. We are now evaluating the effectiveness of the intervention at increasing use of DMARDs in patients with RA.

 

How was this study conducted?

For this study, we collaborated with patients, family physicians, rheumatologists, medical educators and health policy decision-makers and have been actively involving them in the planning and implementation of our educational intervention.

The first step of this study was to engage family physicians in BC in conversations about RA treatment, in order to determine the key messages that are compelling to family physicians to adopt the new guidelines. Using this information, we developed an educational intervention specifically targeted at family physicians that outlines the salient points of current RA treatment guidelines, with clear actionable messages, as well as a tool kit that provides concrete tools to support them in implementing the new guidelines. A pharmacist visits family physicians one-on-one in their offices to discuss RA management and present the tool. This approach is called ‘Academic Detailing’. We will evaluate the effectiveness of this intervention at increasing DMARD use by comparing rates of DMARD use by RA patients of physicians who have received academic detailing compared to a control group who has not.

 

Funding:

This research is funded by a grant from the Canadian Arthritis Network, A National Centre of Excellence.

 

Co-investigators:

This research is a collaboration between the Department of Family Medicine, the Division of Rheumatology and the Faculty of Pharmaceutical Sciences at the University of British Columbia.

Garey Mazowita, MD
Department Chair, Department of Community and Family Medicine, Providence Health Care
Clinical Associate Professor, Faculty of Medicine, University of British Columbia

John Esdaile, MD, FRCPC, MPH
Scientific Director, Arthritis Research Canada
Professor of Medicine, University of British Columbia

Linda Li, BSc (PT), MSc, PhD
Associate Professor, Department of Physical Therapy, University of British Columbia
Harold Robinson Chair / Arthritis Society Chair in Arthritic Diseases
Senior Research Scientist, Arthritis Research Canada

Carlo Marra BSc (Pharm), Pharm D, PhD
Research Scientist, Arthritis Research Canada
Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
Research Scientist, Centre for Health Evaluation and Outcome Sciences, Providence Health Care

Ryan Maltais, BSc, MSc
PhD Candidate, University of British Columbia
Trainee, Arthritis Research Centre

Harpreet Chhina, BSc
MSc Student, University of British Columbia
Trainee, Arthritis Research Centre

Peter Tugwell, MD, FRCPC, MSc
Professor of Medicine and Epidemiology and Community Medicine, University of Ottawa
Director, Centre for Global Health, Institute of Population Health

Michal Abrahamowicz, PhD
Professor, Department of Epidemiology and Biostatistics, McGill University

Marc White, MD
Clinical Assistant Professor, Department of Family Practice, University of British Columbia
Executive Director, Canadian Institute for the Relief of Pain and Disability