The use of Case Managers for arthritis care in First Nations communities



Study Title: Case Managers to Improve wellness in First Nations people who have Arthritis and other chronic conditions – Haida Gwaii and Siksika

Principal Investigator: 
Diane Lacaille, Senior Research Scientist of Rheumatology, MD, MHSc, FRCPC


Partnership: Developed in partnership with Old Massett Village Council, Haida Gwaii, British Columbia and Siksika Nation Tribal Administration, Siksika, Alberta


Principal Investigator: Diane Lacaille, MD, MHSc, FRCPC; Mary Pack Chair in Arthritis Research; Senior Research Scientist, Arthritis Research Canada; Professor and Associate Head Academic Affairs, Division of Rheumatology, Department of Medicine, University of British Columbia


Study start date: Phase one began in 2015. Phase two began in September 2016; the Pilot study will begin in Spring 2017. The Study end date will be in 2018.


Why do this research?   

Compared to other populations within Canada, Indigenous communities have more people living with chronic diseases, including inflammatory diseases. They also have poorer health, shorter life expectancy, and more difficulty accessing health care services. Indigenous people report feeling powerless during health care appointments that lack cultural relevancy or are not consistent with their cultural values. The objective of our research is to study a new model of care for First Nations people living with arthritis as well as other chronic conditions, using a Case Manager residing in their community. This study will assess how well the Case Manager model of care meets people’s needs, impacts care and supports peoples’ health behaviours.


Chronic conditions that will be looked at in this study include: inflammatory diseases,diabetes, obesity, hypertension, cardiovascular diseases, chronic obstructive pulmonary disease (COPD i.e. chronic lung disease), and osteoporosis.


We think the Case Manager model of care will:


  • improve the use of available health care services by First Nations people who are living with both arthritis and another chronic condition;
  • improve culturally-relevant patient-centered care plans;
  • help patients follow care plans developed with the case manager;
  • promote health behavioural and lifestyle changes.


Our research will create new knowledge by evaluating how well the Case Manager approach improves the health care experience and health behaviors of people with arthritis and other chronic conditions. An important aspect of our research is that we will assess whether this model of care meets patients’ expectations of culturally relevant care. By improving the management of arthritis and other chronic conditions associated with arthritis, our research has the potential to improve health outcomes, and also to generally improve the quality of life of First Nations people living with arthritis.



What will be done?


This Case Manager project is being developed with community engagement input to see how the Case Manager model of care can be relevant in their community (Phase 1), and will be pilot tested by introducing a Case Manager in Old Massett, Haida Gwaii, BC and Siksika, Alberta (Phase 2).


Phase 1: Community engagement to design the Case Manager model. Building on our current ties with people in Old Massett and Siksika, we engaged health service providers, administration, Band Council members, and people living with arthritis in various meetings to:


  • Identify community needs and desires;
  • Finalize case manager responsibilities and logistics;
  • Explore how to integrate the Case Manager role with existing health services.


Phase 2: Pilot Study. Using a mixed-methods design, we will see how well the Case Manager model of care works for First Nations people who have both arthritis and one or more chronic conditions.


Intervention: Our intervention utilizes a case management model, which focuses on five central functions: needs assessment, development of treatment and care plans, linking clients to services, monitoring, and advocacy.


A First Nations Case Manager will be hired in Old Massett in Spring 2017 and another was hired in Siksika in January 2017. The Case Managers will receive training in case management, motivational interviewing, brief action planning, as well as arthritis and chronic disease management.


A list of recommendations for the prevention and treatment of each of the chronic conditions and for arthritis management, as well as a list of available health services and resources, will be developed to assist the case managers. Ongoing support in the management of arthritis and other chronic conditions will be provided by study physicians through scheduled debriefing meetings.


The case managers will be assigned to participants for a 12 month period and will interact with patients, their family and health care providers, as required. Consistent with a patient-centred approach, specific tasks will be dictated by patient needs, and will include roles such as:


  • Helping people identify what they need to manage their health in a holistic way.
  • Helping people navigate the health care system and get the services that they need for their medical conditions.
  • Accompanying patients to doctor visits (if needed).
  • Supporting people to develop action plans for healthy living.
  • Monitoring progress, helping to problem-solve as needed.


Who is involved?  Twenty-five participants will be recruited based on the expected case load for a full-time Case Manager. Selection criteria include:


  • age 19 years or older,
  • living on-reserve,
  • having arthritis, systemic autoimmune rheumatic deseases (SARDs) or psoriasis and at least one of the following conditions: diabetes, obesity, hypertension, cardiovascular diseases, COPD, or osteoporosis, diagnosed by a health professional.


How do people get involved? Participants will be recruited through health centre staff and community advertisements in Haida Gwaii and Siksika.


Who is funding the research?

This program is funded by the Canadian Institutes of Health Research (CIHR), with partner funding from the Canadian Rheumatology Association and the Arthritis Society, BC/Yukon Division.

Who is on the research team?


Cheryl Barnabe, MD, MSc, FRCPC, Research Scientist of Rheumatology,  Associate Professor, Division of Rheumatology,  Department of Medicine, University of Calgary; Rheumatologist, Alberta Health Services.

Adalberto Loyola-Sanchez, MD, MSc, PhD, Postdoctoral Scholar, Cummings School of Medicine, University of Calgary

Helen Brown, BSN MSN PhD, Associate Professor, Nursing, 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

Lynden (Lindsay) F.J. Crowshoe, MD, Associate Professor, Department of Family Medicine, Cumming School of Medicine (CSM), University of Calgary.

Research Staff:

June Kaminski, RN MSN PhD(c), Research Coordinator, Arthritis Research Canada

Tessa Kleissen, RN BSN CCRP, Research Coordinator, Cumming School of Medicine, Rheumatology, University of Calgary

Valene Bear Chief, Arthritis Liaison, Siksika


Monica Brown, Health Director, Haida Health Centre, Old Massett

May Russ, Band Council Member and Health Committee member, Old Massett Village Council


Community Partners:

Old Massett Village Council, Haida Gwaii

Siksika Nation Tribal Association

Siksika Health Services, Siksika, Alberta

Arthritis Patient Advisory Board, Arthritis Research Canada

The Arthritis Society, BC & Yukon Division