Rheumatic Diseases, Inflammatory Arthritis, Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA), Connective Tissue Disease
Conditions
Keywords
Rheumatology, Inflammatory Arthritis, Inner City Health
Brief summary
The primary goal of this study is to determine whether providing patient honoraria and/or outreach services can improve the attendance rate of appointments at an inner city rheumatology clinic in Vancouver, British Columbia. The main question it aims to answer are: * Does providing a financial honorarium ($20 for each follow-up appointment with completed bloodwork) improve attendance rate at an inner city rheumatology clinic? * Does providing a personalized outreach service for rheumatic diseases improve attendance rate at an inner city rheumatology clinic? The researchers will compare providing patient honoraria to providing both honoraria and outreach services, and compare each of these to the regular appointment schedule without honoraria or outreach. Participants will: * Undergo randomization to receive honoraria or honoraria and outreach services together * Complete surveys about their health and understanding of their rheumatic disease at baseline, 3-month, and 6-month intervals * Visit the clinic every month for check-ups and monitoring bloodwork if they are started on immunosuppressants for their condition
Detailed description
Our study aims to enhance the existing twice-monthly rheumatology clinic at the Pender Community Health Centre with a rheumatology-specific outreach service for patients with inflammatory arthritis. This service will be provided by a rheumatology subspecialty trainee under the supervision of two attending rheumatologists. This will consist of biweekly phone calls, text messages, or home visits as per the patient's preference, at times flexible to patient needs. This will be in addition to monthly in-person assessment and bloodwork monitoring with adjustment as clinically indicated by their treating rheumatologist. Outreach services will include management of medications and side effects, proactive screening for infections, coordination of rheumatologic and general healthcare with their Primary Care Provider, social service navigation, and reminders for appointments and lab monitoring. All participants will be provided with a $20 honorarium for each in-person assessment they attend as part of the study. The investigators will aim to enroll 20 participants between July 2025 and October 2025. Participants will be randomized to either honorarium with outreach or honorarium alone arms in a 1:1 fashion, stratified by housing status (unhoused and emergency sheltered in one strata, provisionally accommodated and stably housed in the second strata). All enrolled participants will receive a $20 honorarium for each in-person assessment with completed monitoring bloodwork as requested by the treating rheumatologist. The program will last 6 months for each patient from time of enrolment, or until a patient chooses to leave the program, whichever is sooner. At baseline, participants will complete two surveys: one on their general health status, and one specific to their rheumatic disease. At the 3-month and 6-month visits, these surveys will be repeated, and a semi-structured interview will be completed to obtain feedback on the pilot program. The outcomes of this study will inform how rheumatologists can better care for those who live with inflammatory arthritis and are also marginalized by extreme poverty and/or housing instability. The investigators plan on disseminating and discussing results with our participants, community members, inner city physicians, and rheumatologists. If there are specific positive themes or outcomes from the study, the investigators will advocate for additional resources to permit long-term implementation and further study to confirm results, make further improvements to our program, and improve generalizability.
Interventions
BEHAVIORALHonoraria
A $20 honorarium for each appointment attended with completed bloodwork if requested.
BEHAVIORALOutreach
A personalized outreach service specific for rheumatic disease.
Sponsors
Mary Pack Arthritis Center
University of British Columbia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Have a diagnosis of inflammatory arthritis secondary to an autoimmune rheumatic disease * Be attached to one of the Vancouver Coastal Health Community Health Centres for primary care * Be willing to attend in-person appointments at Pender Community Health Centre * Be at least 18 years of age and capable of consenting to participation * Be able to receive medical care in English.
Exclusion criteria
* Have cognitive impairment or an untreated psychiatric condition that would severely impair ability to engage with outreach or treatment * Have no reasonably reliable method of contact (phone, email, social media, etc.)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Attendance at in-person follow-up appointments | Cumulative over 6 months | Adherence to in-person follow-up measured by the ratio of appointments attended to appointments scheduled. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Disease Activity Index (CDAI) | 3-month and 6-month intervals. | The change in Clinical Disease Activity Index from baseline to 3-months and 6-months. The Clinical Disease Activity Index is a validated disease outcome measure in Inflammatory Arthritis ranging from 0 to 76. A higher score means a worse outcome. |
| Patient Qualitative Feedback | 3-month and 6-month intervals. | Patient qualitative feedback on the program via semi-structured interview. |
| Patient Reported Understanding of Disease and Medications | 3-month and 6-month intervals. | Patient Reported Understanding of Disease and Medications, as measured by likert scale at baseline, 3 months, and 6 months. The likert scale will range from 1 to 10, with higher scores indicating better understanding. |
| Patient reported pain related to arthritis | 3-month and 6-month intervals | Patient reported pain related to arthritis on a visual analogue scale. The visual analogue scale is a validated measure of pain in arthritis, where participants are asked to indicate their severity of pain within the previous week on a 0 to 100mm score. A score of 0 indicates no pain, and a score of 100 indicates worst possible pain. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Serious Infections | Cumulative over 6 months | Number of Serious Infections Requiring Urgent Care or Emergency Department Visitation |
| Tender Joint Count | At the 6-month interval. | Change in the number of tender joints as measured by their treating clinician on a 28-joint count basis. |
| Swollen joint count | At the 6-month interval. | Change in the number of swollen joints as measured by their treating clinician on a 28-joint count basis. |
| Number of Emergency Department Visits During the Study Period | Cumulative over 6 months | Number of Emergency Department Visits During the Study Period |
| Number of Days in Hospital During the Study Period | Cumulative over 6 months | Number of Days in Hospital During the Study Period |
Countries
Canada
Contacts
Primary ContactChu Ming (Alec) Yu, MD
Outcome results
None listed