Updating Rheumatology Skills in Primary Care: The Maine Arthritis Partnership (MAP) Program

Transcription

1 Updating Rheumatology Skills in Primary Care: The Maine Arthritis Partnership (MAP) Program Advisory Board Jacqueline B. Cawley, DO; Sr. Director for Ambulatory Care and Preventive Health, MaineHealth Margaret Duffy, MA; Regional Program Director for the Arthritis Foundation Margaret A. Duston, MD; Rheumatologist, Arthritis and Rheumatology Marc L. Miller, MD; Rheumatologist, Rheumatology Associates, Portland Daniel K. Onion, MD, MPH; Director, Maine-Dartmouth Family Practice Residency Program, Professor of Community and Family Medicine, Dartmouth Medical School, Waterville Robert A. Sylvester, MD; Rheumatologist, Lewiston FBR Staff Robert F. Ritchie, MD; Principal Investigator Walter C. Allan, MD; Clinical Liaison Wendy Y. Craig, PhD; Senior Research Scientist Thomas B. Ledue, BA; Program Manager David Groft, MS; Field Coordinator Dwight E. Smith, BA; Director of Computer Services

2 The Impact of Arthritis 36% People 18 or older with self-reported, doctordiagnosed arthritis. Source: CDC, Behavioral Risk Factor Surveillance System, 2003.

3 Goals Enhance knowledge and understanding of arthritis among primary care providers (PCPs) in Maine and increase their role in diagnosis and management of arthritis Reinforce linkages among rheumatologists and PCPs at the community level Coordinate office-based continuing medical education that provides ongoing training about issues related to arthritis

4 Program Design Baseline surveys MAP Guide Preceptorship

5 Baseline surveys of Maine PCPs Survey 1, n = 750; 18% response rate, 66 communities 38% comfortable with the initial assessment of arthritis 40% of patients travel >1 hour to see a rheumatologist. PCPs contact a rheumatologist an average of 17 times a year for consultation, referral, or for patient information. Survey 2; n = 13; pilot program PCPs, 30% rural 85% do not use a standardized questionnaire None were 100% confident in their ability to identify rheumatoid arthritis 38% of referrals are due to suspected inflammatory disease Average wait time for a referral appointment is 2-4 months 69% would like more guidance about identifying inflammatory arthritis

6 The MAP Guide Pilot Project A handbook to assist PCPs with the reliable and systematic assessment and management of joint pain Target Disorders Osteoarthritis Rheumatoid Arthritis Gout MAP Guide Structure Diagnostic algorithms Joint pain evaluation form Disease description Relevant Guidelines Resources for physicians and patients Strengths: easy to use, concise, solidifies diagnosis and outlines treatment options. Simplified process of dealing with joint pain Weaknesses: none (75%), smaller print version or electronic format; the 4-month trial period was too short for full evaluation Recommendations: expand the list of covered diagnoses, provide more information on how to protect joints Overall rating by 10 participants: 8.6/10

7 MAP Guide: Initial Evaluation of Joint Pain Form MAP Guide users completed the form ~3x/month Average time required to complete form: 4 min Most used the form internally as part of the patient s medical record

8 Rheumatology Preceptorship Maine Arthritis Partnership Goals: Improve PCP s ability to diagnose rheumatologic disorders, particularly inflammatory arthritis Improve PCP s ability to perform a comprehensive joint exam Improve efficiency of referral process 2007 Preceptorship Program in Rheumatology to enhance and update clinical skills in musculoskeletal examination and diagnosing arthritic conditions

9 Preceptorship Evaluation (Scale: 0-100) Did the program meet the stated objectives? 93 Was the information clearly presented? 93 Did you have adequate time to ask and receive answers to your questions? 96 What was the practical value of the information presented? 96 Overall rating by 13 participants: 95

10 SUMMARY The MAP Guide is a useful resource for PCPs in the clinical setting The MAP preceptorship provides PCPs with valuable practical education in joint pain evaluation

11 The Future of the MAP Program Seek funding to: Integrate MAP Guide and Preceptorship Expand the Program statewide Expand the Program to serve PAs and NPs