The Rheumatology Access Expansion (RAE) initiative showed significant improvements in patients’ knowledge of rheumatoid arthritis (RA) and resulted in better diagnosis and management of their disease, Jennifer Mandal, MD, told the audience at the ACR Convergence on November 12.

Dr Mandal is a rheumatology specialist and an assistant professor of medicine at the University of California-San Francisco.

Patients among communities of color and rural populations suffer from a disproportionately greater burden of RA in United States, among which the Navajo Nation—the largest American Indian reservation, spanning 27,000 square miles across 3 states, and home to 250,000 tribal members—faces a severe shortage of local rheumatology providers, Dr Mandal noted. Because of this shortage, the provision of most RA care falls upon the primary care providers (PCPs).

“Our goal was to develop a novel RA training program for Navajo Area PCPs, and to study the impact of the program on PCPs’ knowledge and self-reported confidence in diagnosing and managing RA,” Dr Mandal explained in describing the purpose and objectives of the RAE initiative.

Dr Mandal and colleagues developed the RAE initiative— a 2-week RA training program for PCPs—after conducting a needs assessment and gathering expert insights from an interdisciplinary team of rheumatologists, a pharmacist, and Navajo cultural interpreters.

The researchers facilitated weekly interactive webinars to encourage 2-way communication between physicians and patients; encouraged PCPs to complete survey questions regarding RA diagnosis and management before and after the course; and conducted a final RA medical knowledge test. They were also asked to rate the usefulness of each session.

Among those who completed the knowledge and confidence surveys were 18 PCPs—15 physicians, 1 nurse practitioner, 1 physician associate, and 1 community health worker. In the self-reported survey, researchers saw a little under a 20% increase in confidence for the diagnosis of rheumatoid arthritis and a little over a 20% increase in confidence for the management of rheumatoid arthritis.

Regardless of the knowledge domains, the posttraining performances were significantly higher than pretraining performances. While 22% saw improved performance on their knowledge test, the mean session usefulness rating was 4.52 out of 5.

“We successfully designed and implemented a 12-week RA training program for Navajo Nation primary care providers,” said Dr. Mandal. “The curriculum, now in its third cohort, has been very well received and has improved the providers’ knowledge of evidence-based RA guidelines and their confidence in disease management.”

With this model, Dr Mandal strongly believes that we are on the right track in improving rheumatology care. Overall—and especially in rural settings—the model design is cost-effective, logistically feasible, and easily scalable.

“By providing high-quality rheumatology training and mentoring to front-line primary care providers in vulnerable communities, this program could have a positive impact on many thousands of patients suffering from rheumatic diseases,” Dr Mandal said.

—Priyam Vora

Reference:
Mandal J. Poster 0005: The Rheumatology Access Expansion (RAE) initiative: Improving rheumatoid arthritis care on Navajo nation through primary care provider education. Presented at: American College of Rheumatology Convergence. Philadelphia, Pennsylvania. November 12, 2022.