Community Rheumatology-ACPAC ERP Model of Care
Vandana Ahluwalia MD, FRCP (c)
Dr. Ahluwalia is an urban community rheumatologist practising in Brampton, Ontario. She works collaboratively with ACPAC program trained ERPs within a shared model of arthritis care supporting the inclusion of these highly trained practitioners as they triage, follow up and monitor the care of patients with inflammatory arthritis. Dr. Ahluwalia reports that the presence of an ACPAC program trained ERP such as Tiffany Larsen has resulted in an increased number of patients seen; more effective management of wait lists; increased access to care and decreased wait times resulting in earlier and improved remission rates and achievement of treat to target practice.
Tiffany Larsen PT
Tiffany Larsen is an ACPAC program trained physical therapist practitioner who works in an extended role capacity within a shared model of care with urban community rheumatologists in Brampton, Ontario. This position requires an experienced and well-trained arthritis care practitioner to triage, follow-up and monitor patients with inflammatory arthritis. Her role exemplifies the capacity achieved by the presence of an ACPAC trained practitioner working collaboratively with a rheumatologist specialist such as Dr. Vandana Ahluwalia to result in increased access to and improved efficiency of best practice care for patients living with inflammatory arthritis.
Urban Academic Rheumatology-ACPAC ERP Model of Care
Robert Inman, MD, FRCP (c)
Dr. Inman is a rheumatologist practising in an urban-academic setting at The Toronto Western Hospital, University of Toronto where he is also a co-director of the Spondylitis program. Laura Passalent and Chris Hawke are both ACPAC Program trained ERPs with whom Dr. Inman works in a new model of care and collaborative capacity. Their presence allows for improved capacity to screen and triage patients with Ankylosing Spondylitis with the aim to better address the challenge of an existing gap in care for these patients. According to Dr. Inman, the strategy and benefit of this shared model of care, which incorporates the expertise of a well-trained ACPAC ERP to screen patients from the community presenting with back pain, allows for the triage mechanism to connect the patient to a pathway of care. Dr. Inman identifies the impact of the presence of an ACPAC ERP for the patient with ankylosing spondylitis to include 1. Shortening inappropriate wait times and thus decreasing the lag time from onset of symptoms to treatment, 2. Improved quality of care for patients and 3. Expanded research opportunities.
Laura Passalent, PT, MHSc
Laura Passalent is an ACPAC Program trained physiotherapist practitioner who works at the Toronto Western Hospital in the Ankylosing Spondylitis program with Dr. Inman since 2008. The APCAC ERPs work within a new model of care screening for patients with suspected inflammatory back pain. This collaborative practice role involves the ability to perform a thorough assessment, including history taking, physical exam and the ordering of appropriate laboratory and radiograph investigations to screen for ankylosing spondylitis. This screening opportunity allows for early detection of disease which is critical for this patient population. According to Laura Passalent, this new model of shared care and close interprofessional working relationship allows for expedited care of a patient with spondylitis by a rheumatologist, and allows for earlier diagnosis and treatment which ultimately affects outcomes in the end. The presence of an ACPAC ERP in the clinic has improved wait times for the patient to see a rheumatologist in this setting reducing this period from 15 weeks to 3 weeks.
Telehealth (Urban-Remote) Rheumatology-ACPAC ERP Model of Care
Rachel Shupak MD, FRCP (c)
Dr. Shupak is a rheumatologist practising in an urban-academic setting at St. Michael’s Hospital, University of Toronto. She is also the Medical Director of the ACPAC program. Dr. Shupak works with Jocelyne Murdoch, an ACPAC program trained occupational therapist practitioner working for the Arthritis Society in Sudbury, Ontario. Dr. Shupak points to the critical role that Jocelyne plays in triaging and linking the care of patients with inflammatory arthritis in some regions of Northern Ontario with her as a rheumatologist practising in an urban centre using the Ontario Telehealth Network. It is within this capacity that the APCAC ERP, as an experienced and well-trained practitioner of arthritis care, makes the delivery of healthcare to these patients possible. This relatively new model of care provides access to and allows for more timely delivery of care to patients who might not otherwise receive care. A willingness to work collaboratively within this innovative model of care also allows for additional cost savings to the healthcare system, to the patient and their families.
ACPAC’s System Level Impact
The ACPAC program was established in 2005. Since its inception, 100% of graduates have been satisfied with the program and found it extremely relevant to their clinical practice. Information on the early but extensive health services evaluation of ACPAC program graduates can be found in the ACPAC System Level Outcome Report which was presented to the Ministry of Health and Long Term Care Ontario in January, 2012.
An outline of the key implications of the ACPAC system-level evaluation for healthcare provision by ACPAC trained ERPs identified positive changes in terms of access (particularly in rural and remote regions), strengthened healthcare capacity, perceived impact on patient outcomes, and opportunities for further role promotion and expansion. The ACPAC program and its graduates (n=79) have been continuously responsive to a rapidly evolving healthcare environment with on-going evidence of improved, context-driven processes and positive outcomes.