There is a growing number of people presenting with inflammatory arthritis that is outpacing our ability to provide care.
There is a well-recognized need for an enhanced, inter-professional, patient-centred approach that improves the delivery of safer and more effective care to a rapidly growing population of patients with arthritis. On the other hand, there has been a shortage and decline in traditional arthritis health care providers (i.e. rheumatologists).
The Advanced Clinician Practitioner in Arthritis Care Program (ACPAC) was developed in 2005 under the guidance of Dr. Rachel Shupak, Dr. Rayfel Schneider, and Dr. Katie Lundon.
The ACPAC program is first and foremost a clinical training program. An ACPAC Extended Role Practitioner (ERP) has been prepared to work in shared care settings for ongoing management and triage, two identified requirements to establish new inter-professional models of care. These practitioners have expanded and advanced knowledge, clinical skills, and attitudes related to arthritis care obtained through additional formal training and evaluation with measured competencies.
The ACPAC program is an accredited certificate (advanced) program through the University of Toronto. The program spans 10 months each year from September to June and consists of five on-site training weeks in Toronto. It involves an intensive formal, competency-based, hybrid academic and clinical curriculum. There is a very rigorous evaluation process in place. It is an inter-professional education program involving more than two groups including PT, OT, and RNs experienced in arthritis care.
The curriculum consists of Advanced Arthritis/MSK Theory, Advanced Assessment and Management Interpretive Sessions, Advanced Arthritis/MSK clinical Practice, and Health Promotion, Advocacy, and Leadership in Arthritis Care. The faculty represents multiple professions and it is multi-disciplinary within each profession. It involves over 26 rheumatologists and 13 orthopaedic surgeons.
The teaching of the ACPAC program is rooted in "thinking beyond the joint" to consider the systemic nature of rheumatic disease. The ACPAC program collects comprehensive data with a pre- and post-performance evaluation to identify significant improvements in both written and practical skills.
There are 54 graduates of the program working in rheumatology and orthopaedic roles. The distribution of ACPAC graduates includes 45% in urban-academic regions, 39% in community-based practice, and 16% in remote regions. ACPAC therapists play a major role in the care of arthritis patients in under-serviced areas.
There have been significant outcomes at the system level including improved access to arthritis care and reduced wait times. Therapists have improved quality of care and education, better shared responsibility of care, and contribution to educational resources for other health professionals.
The ACPAC program has provided a substantial contribution to arthritis care in Ontario and now throughout Canada. The ACPAC program is a model that has been reviewed in the international arthritis community.
So, what are the issues with the model? One of the major barriers facing ACPAC ERPs is the development of a new funding model for payment. Other challenges include the ability for ACPAC therapists to directly refer to specialists, and a change in the paradigm of the delivery of care from traditional health care roles.
Rheumatologists must encourage the development of ACPAC ERPs and foster their integration within the rheumatology community. Bravo to the ACPAC program!