The purpose is to apply design-thinking principles to the development, evaluation and implementation of early axSpA screening for patients referred from primary care settings.
The design-thinking approach was applied to a spondylitis program within an urban academic hospital located in Toronto, Canada. “Needfinding” considered the literature to date on the subject of diagnostic delay in axSpA and included topics of health services (i.e. health human resources; access to care) and clinical impact (i.e. outcomes of early management). “Ideation” was determined through review of existing models of care, inventory of available clinical and administrative resources, and use of ACPAC program trained extended scope physiotherapists. A “prototype” model to screen patients with IBP was developed and “tested” within the spondylitis program. “Implementation” was possible through collaboration with primary care providers and a primary care back pain program in the surrounding hospital communities. Assessment of scalability through a provincial pilot is underway.
“Needfinding”: diagnostic delay in axSpA is a multifactorial problem that includes lack of specific biomarkers; background “noise” of more prevalent mechanical back pain, and health system gaps between rheumatology supply and demand. “Ideation” and “prototyping”: the use of ACPAC trained physiotherapists working in extended scope roles has been shown to improve access to care. At the primary care level, patients with back pain > 3 months duration; onset age 50 years, with at least one feature of IBP were referred for screening by ACPAC program trained physiotherapists. “Testing”: this model demonstrates improved access to rheumatology and early diagnosis for patients with axSpA (2 years for non-radiographic axSpA and 7 years for ankylosing spondylitis). Implementation: scalability of this model is currently underway at a provincial level within Ontario.
The application of design-thinking to diagnostic delay in axSpA has generated a novel and effective model to facilitate early identification and initiate appropriate management. A similar approach may be considered in other areas of care where there are complex problems awaiting creative solutions.
Physiotherapists are increasingly working in non-conventional roles in both advanced and extended scope capacities. This study demonstrates the impact physiotherapists trained in advanced musculoskeletal care can have on specific patient populations and on health system gaps. Physiotherapists with advanced/extended scope training could be similarly integrated within other care settings and with other patient populations.
advanced practice
spondyloarthritis
