JointHealth™ express   November 13, 2022

#ACR22 Update: Health Care Provider Training Program Improves RA Care on Navajo Nation

At a presentation at the American College of Rheumatology annual scientific meeting, researchers described a new program that offers rheumatoid arthritis (RA) training to primary care providers in the Navajo Nation, the largest American Indian reservation in the United States. Despite the high prevalence of RA and associated morbidity and mortality in this Indigenous community, the Navajo Nation has a single rheumatologist serving 250,000 tribal members. As a result, most RA care has shifted to primary care providers on the reservation, who do not feel confident prescribing RA medications or managing the disease.

In addition to developing the RA training program, known as the Rheumatology Access Expansion Initiative, researchers wanted to understand how the program affected health care provider knowledge and in RA diagnosis and management.

“The United States faces a critical shortage of rheumatology providers, and this deficit is expected to worsen dramatically over the next decade. In addition, racial and ethnic minorities, particularly Black, Latino, and Indigenous peoples, often face longer delays in diagnosis and treatment and [have] less access to rheumatology care,” explains the study’s lead author, Jennifer Mandal, MD, an assistant professor at the University of California, San Francisco (UCSF).

Dr. Mandal says for many patients, the physical distance from the nearest rheumatologist is a significant barrier. Meanwhile, many primary care providers have no choice but to attempt to diagnose and treat inflammatory arthritis with little or no specialist guidance.

The 12-week training program was designed by a team of rheumatologists, pharmacists, and Navajo cultural interpreters. It is based on an established educational model, which uses videoconferencing to conduct seminars with community providers. Participants included 15 physicians plus a nurse practitioner, physician assistant, and community health worker.

“We successfully designed and implemented a12-week RA training program for Navajo Nation primary care providers. The curriculum, now in its third generation, has been very well received and has improved the health care providers’ knowledge of evidence-based RA guidelines and their confidence in disease management,” Dr. Mandal says.

Future plans include expanding the program to other Native American communities and potentially developing a new course on ankylosing spondylitis. The researchers also intend to look at patient outcome data, but “given the history of medical exploitation of American Indians, it is important to us to establish a solid track record of trust and reliability in the Navajo community for several years before we ask permission to review patient health records.”

The Canadian Context

The health inequities faced by Indigenous Peoples in Canada is an important issue to understand in our arthritis community where Indigenous Peoples have some of the highest rates of serious or life–threatening arthritis in the world, are at greater risk for becoming disabled by arthritis and also face a high rate of co-morbidities like heart disease, hypertension, asthma and cancer.

Arthritis Consumer Experts (ACE) has helped lead advocacy efforts across Canada to support the integration of virtual care and to expand the role of arthritis health professionals (AHPs) to serve hard-to-reach communities to improve health outcomes and address health inequities.

ACE has been joined by other arthritis patient organizations and rheumatology and AHP leaders at government meetings where it has advocated for AHPs to provide cost-effective care to Indigenous Peoples with inflammatory arthritis and improve access to care in underserved areas by establishing Indigenous community-based “patient care facilitators” to coordinate culturally appropriate care between clinicians and patients within their community.

These recommendations are based on important work conducted by Canadian researchers including Dr. Cheryl Barnabe. To learn more, click here to see the findings of a study conducted by Dr. Barnabe.