The ACPAC program is an opportunity to lead change in the transformation of arthritis care in Ontario and beyond

Overview

The Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program is a unique post-licensure academic and clinical educational program. It prepares select and experienced physical therapists, occupational therapists, nurses, and chiropractors for extended practice roles by providing advanced training in the diagnosis and management of patients with arthritis.

The ACPAC program was developed in response to:

  • A well-recognized need for an enhanced interprofessional approach to care that allows more efficient management of a growing population of patients with arthritis (rheumatoid arthritis and osteoarthritis)
  • A progressive decline in number of traditional arthritis care specialists resulting in inappropriate wait times for care
  • A need to retain and more appropriately utilize existing health professionals with expertise in the musculoskeletal field to improve wait times and efficiency of arthritis care.

The aim is to further develop a relevant human health resource to improve access to specialist care. The ACPAC-trained ERP is important to the development of innovative models of arthritis care across various clinical settings in Ontario and beyond.

This innovative, interprofessional program is hosted in Toronto Canada by St. Michael’s Hospital in collaboration with The Hospital for Sick Children. It is a competency-based certificate program offered at the post-licensure level in association with the Office of Continuing Professional Development, Faculty of Medicine, University of Toronto.

'Without the help of the ACPAC program-trained practitioners, managing the demand for rheumatology services in Northwestern Ontario would be impossible.'

-Dr. Wes Fidler
View more testimonials

ACPAC-Trained ERP Workforce in Canada

Recent Publications

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice.
Ahluwalia, V., Larsen, T., Kennedy, C., Inrig, T., Lundon, K. 2019.
Published in The Journal of Multidisciplinary Healthcare.
View Paper

Objective: To facilitate access and improve wait times to a rheumatologist’s consultation,
this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis
care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected
inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the
impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and
time-to-treatment-decision.

Materials and methods: A community-based ACPAC-trained ERP triaged new referrals for
suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority
basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement
between ERP and rheumatologist (Kappa coefficient and percent agreement); and the
time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart
review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in
the solo-rheumatologist versus the ERP-triage model.

Results: One hundred twenty-one patients were triaged. The ERP designated 54 patients for
priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value
[PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none
were determined to have IA by the rheumatologist (100% negative predictive value [NPV]).
Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient
0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for
patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7,
range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).

Conclusion: A well-trained and experienced ERP can shorten the time-to-Rheumatologistassessment
and time-to-treatment-decision for patients with suspected IA.
Keywords: rheumatology, health services accessibility, interprofessional relations, community
health services, integrated delivery systems

Improving access in rheumatology: Evaluating the validity of a paper triage process involving an advanced practice physiotherapist through a retrospective chart review
Bignell, K., Bender, C., Lichtenstein, A., McArthur, B., Musselman, K., Kay, T., Farrer, C.
Published on 20 Jun 2018.
View Paper

Objectives: This study evaluated a standardized paper triage process conducted by an advanced practice physiotherapist (APP) at a rheumatology center. The aims were to (1) determine the concordance between paper triage priority assignment and the rheumatologist’s diagnosis; (2) determine the sensitivity and specificity of the paper triage process; and (3) assess reasons for incorrect priority ranking. Methods: Referrals were triaged by a formally trained APP into one of the three priorities, guided by a priority referral tool. A retrospective review of 192 charts was performed. Raw proportion of agreement between paper triage and rheumatologist’s diagnosis was supplemented by a prevalence-adjusted bias-adjusted kappa (PABAK). Priority categories were collapsed to calculate sensitivity and specificity. For discordant cases, additional information was collected from the referral and chart to identify potential features leading to discrepancy.

Results: Overall agreement was 76%. The PABAK was 0.80 [95% confidence interval 0.70–0.90]. Sensitivity ranged 0.64–0.92 and specificity ranged 0.81–0.94, depending on the priority category. Forty-six cases were discordant, with the APP choosing a higher priority in 37 cases. An incorrect diagnosis from the family physician with no supporting information for the paper triage led to discordance in 16 cases. Conclusion: A standardized paper triage process conducted by an APP showed substantial concordance, sensitivity, and specificity.

The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario [abstract].
Bombardier C, Brooks S, Bell M, Cesta A, Kendzerskaya T, Sweezie R, Widdifield J, Fullerton L, Ahluwalia V, Karasik A. Arthritis Rheumatol. 2016; 68 (suppl 10). Accessed January 23, 2017.
View Paper

Triage by an ACPAC trained ERP resulted in a high number of patients with suspected IA/CTD being correctly prioritized for a rheumatology consultation. For prioritized patients, the wait time was less than the provincial median. These results suggest that an ERP working in a triage role can improve access to rheumatology care for patients with suspected IA.