OP0117-HPR FROM CURE TO COPING: EXPLORING TASK-SHIFTING BETWEEN NORWEGIAN RHEUMATOLOGISTS AND OCCUPATIONAL THERAPISTS IN THE CARE OF HAND OSTEOARTHRITIS

Abstract

BackgroundTask-shifting between physicians and other health professionals is increasingly used as a strategy to optimise health care services. However, there is a lack of evidence regarding task-shifting within the field of rheumatology, specifically hand osteoarthritis (HOA). HOA is a highly prevalent rheumatic joint disease, and the number of people living with debilitating HOA will continue to rise in the coming decades (1, 2). HOA is diagnosed based on clinical examination and the first choice of treatment is non-pharmacological. Despite this, patients with HOA are increasingly referred to rheumatologists (RTs) in specialist care, contributing to long wait times and bottle-necks within the health care service. A possible solution to this challenge is task-shifting to occupational therapists (OTs).ObjectivesTo explore the process of task-shifting in the care of patients with HOA between RTs and OTs in a Norwegian health care context.MethodsThis is a multi-centre qualitative study. Individual semi-structured interviews were conducted in-person or digitally with RTs and OTs between December 2020-June 2021.They were audio-recorded and transcribed verbatim. Reflexive Thematic Analysis was employed to analyse the data, and carried out in NVivo.ResultsIn total, 17 participants were interviewed; 9 RTs and 8 OTs. Majority of respondents were female (n= 14), had an average of 20,5 years of experience and were 48,5 years old. Interviews lasted on average 90 minutes, (range: 45-120 minutes). The analysis resulted in 5 main themes(1) Attitudes towards task-shifting of HOA care: Both RTs and OTs were overwhelmingly positive about task-shifting and reported OTs to be better suited caring for patients with HOA than RTs. There was agreement amongst RTs that generally, they had little to offer HOA patients besides information.(2) Desirability of caring for HOA: RTs felt no occupational “ownership” of the HOA diagnosis due to the lack of curative medical treatment, and would prefer HOA patients to be seen by an OT. OTs on the other hand perceived themselves as a profession with tools, skills and competencies that would benefit patients with HOA.3) Practical and theoretical knowledge: OTs and RTs viewed different kinds of knowledge as central for task-shifting. Respondents emphasised that OTs must have good anatomical knowledge of the hand and confidence in identifying differential diagnoses that could potentially be more serious. Lack of knowledge lead to insecurity and hampered successful implementation of task-shifting. (4) Communication between RTs and OTs: RTs perceived OTs to be passive in communicating their willingness and competence in caring for this patient group. They expressed a wish for more “self-promotion” from OTs. OTs and RTs viewed communication between them as essential for task shifting. Good communication, understanding and inquisitive conversations acted as facilitators.(5) The importance of informal interpersonal relationships in the workplace: Informal interpersonal relationships facilitated trust and subsequent task-shifting between RTs and OTs. Personal relations directly affected engagement in the task-shifting process.ConclusionThe findings show a unanimous wish for HOA care to be shifted from RTs to OTs. Attitudes towards HOA as a diagnosis, interpersonal relationships between RTs and OTs, and knowledge are key facilitators and barriers affecting this process. The findings contribute to the growing body of knowledge on strategies used to optimise health care services and can be used in the design and implementation of new care pathways for patients with HOA.