Co-Developing FlexCAre: Insights from Canadian Health Care Providers on Optimizing Care Delivery

Abstract

To improve the delivery and outcomes of inflammatory arthritis (IA) care in Canada, we are co-designing FlexCAre in partnership with adults living with IA and arthritis health care providers (HCPs). FlexCAre aims to provide flexible delivery of care to better meet the individual needs of patients and achieve better health outcomes. This study reports findings from focus groups conducted with Canadian IA HCPs to explore their experiences, values, and preferences regarding the timing, modality, and nature of IA healthcare visits. Structured online 90-minute focus groups were conducted with HCPs using a predefined question guide to explore opportunities to optimize IA care delivery. Transcripts were thematically coded and analyzed to identify patterns to inform new approaches, interventions, and policy. The 30 HCPs had a mean (SD) age of 64 (13) years. They included rheumatology nurses (67%), rheumatologists (30%) and pharmacists (3%) in BC (60%) and AB (40%) who had been practicing on average 16 years. Three overarching themes were identified: (1) The challenge of whole person care. HCPs noted that when patients lack access to primary care, providing whole person care can feel overwhelming and limits their ability to focus on complex, dynamic disease-specific needs. Equity gaps are greatest among older adults, racialized groups, individuals with mobility limitations, and in rural areas. Unrealistic patient expectations regarding the scope of services rheumatologists can offer were noted, particularly when patients lack a family doctor and/or mental health services. (2) The need for education and support from IA interprofessionals. Sustaining interprofessional teams remains challenging, even with provincial funding. HCPs emphasized the value of rheumatology team members to educate patients and fill gaps by providing virtual visits, responding to messaging systems, and returning calls. (3) Individualizing care through flexible tools and strategies. HCPs varied in their use of and preferences for virtual care and between-visit monitoring, and tailoring approaches to patient needs, disease status, and life context. Flexibility regarding visit scheduling, type, and monitoring was deemed essential. Several noted that when medication approval depends on symptom assessments, patients are more likely to complete questionnaires. E-health systems can provide disease education and self-management skills training. HCPs identified key challenges and opportunities to improve IA care delivery. Findings underscore the importance of flexible, integrated, and patient-centered approaches to meet diverse needs, support whole person care, and reduce the burden on providers and meet patient needs. These insights are helping inform the co-design of FlexCAre.