Understanding multidisciplinary care for people with rheumatic disease in British Columbia, Canada, through patients, nurses and physicians voices: a qualitative policy evaluation

Abstract

Background In 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a ‘Multidisciplinary Care Assessments’ (MCA) billing code (G31060). Objective To describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists. Methods We conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 – August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed. Results We interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed. Conclusion Our results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals’ skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients.

[Retracted] Analysis of the Natural Conditions and Geographical Factors of the Formation of Hui‐Style Prints

“…Finally, the analysis of the natural conditions and geographical factors for the formation of Hui-style prints is then completed, which can re ect the basic connotation of national culture [11]. In terms of the formation of Hui-style printmaking, because the Huizhou area is located in the mountainous area of southern Anhui, it has the characteristics of relatively weak real estate, more local mountainous areas, and fewer elds [12]. If only the natural environment is analyzed, the smooth formation of Hui-style prints during this period will not be guaranteed, and the increasing in uence of the natural environment on Hui-style prints leads to the phenomenon that most painters struggle with nature and strive for survival advantages.…”

Effect of a Billing Code to Reimburse Nurse‐Supported Rheumatology Care on Health Care Costs and Access: An Interrupted Time Series Analysis

“…2 The MCA code is popular with rheumatologists, used by >70% of all rheumatologists in BC, 2,4 including 80% of new rheumatologists, 4 and is associated with greater happiness and job satisfaction. 5 Our analysis had some limitations. First, there were slight differences in the characteristics of patients treated by rheumatologists who did or did not use the MCA code; however, none were statistically significant.…”

“…Rheumatologists and patients report that using the MCA code allows more consultation time for discussing disease and treatment, leveraging complementary skills of rheumatologists and nurses, 5 and having more appropriate testing and immunization to mitigate treatment risks as well as more drug, disease, and general education and counseling to promote self-management. 5 Rheumatologists feel that the MCA code helps reduce waiting lists, 5 which is supported by population-based evidence of an association between use of the MCA code and shorter referral times from primary care to the first rheumatologist visit and receipt of the first DMARD for people with RA. 4 The time from symptoms to the first DMARD for people with RA is a marker of quality care, and evidence suggests that the MCA code is popular with patients and rheumatologists.…”

“…2 This includes increasing the overall volume of patients seen, the number of services provided by rheumatologists, and reducing wait times for new patients. 2,[4][5][6] One remaining question regarding the MCA code is its impact on health system costs. More than 70% of BC rheumatologists now use the MCA code, billing it 30,000 times in 2022 at a total cost of $6.5 million.…”

“…Nurses employed through the MCA code contribute to patient assessments, medication education, and self‐management of disease, and evidence suggests this has increased patient satisfaction and rheumatologist capacity 2 . This includes increasing the overall volume of patients seen, the number of services provided by rheumatologists, and reducing wait times for new patients 2,4–6 …”