POS0156-HPR ‘THE RIGHT ADVICE, IN THE RIGHT WAY AND AT THE RIGHT TIME’: AN INNOVATIVE MULTIDISCIPLINARY APPROACH TO ADDRESS CLIENT-IDENTIFIED PARTICIPATION NEEDS IN EARLY INFLAMMATORY ARTHRITIS

Abstract

Background:Inflammatory arthritis (IA) is a complex life-long disease with negative consequences on occupational performance and significant impact on meaningful life roles. International guidelines for the clinical management of IA consistently recommend early intervention and a multidisciplinary (MDT) approach as the optimum method to address the medical, symptom and broader life impacts, however, barriers to timely access to the MDT is a common issue in clinical practice. Limited research has explored how clinical services support broader life impacts and participation restrictions associated with early disease as part of routine healthcare. Four rheumatology services in Ireland have recently reconfigured to provide an MDT-led early arthritis service which operates in parallel to traditional medical clinics. Staffed by nurses, occupational therapists, and physiotherapists this service provides assessment and management to clients with a new diagnosis of IA along a model of care within four to six weeks of diagnosis with mechanisms to follow the client over their first year of diagnosis.Objectives:To explore how a novel MDT-led early arthritis service addresses client-identified participation restrictions associated with early IA.Methods:A qualitative description (QD) study was used to explore the perspectives of service providers and service users of this MDT-led early arthritis service. Data were gathered using one-off focus groups with service providers, and individual interviews with service users.Results:All staff (n=15) currently working in these services participated in the focus groups. Forty-three service users with IA participated in individual interviews (males n=12: females n=31); diagnosis duration ranged from 5 to 24 months. QD principles and thematic analysis were used in data analysis.Extensive limitations in everyday activity and restriction in participation in meaningful, age-appropriate life roles in early IA were outlined by service users and service providers. Participants described how the MDT-led model provided automatic and immediate access to services focussed on identification and management of occupation-based participation restrictions early in the disease. Participants described how the model used a flexible approach that ensured; ease of early access to a full MDT, prolonged support from the MDT, and a person-centred approach incorporating social prescribing and self-management principles. Service users emphasised the strength of the MDT approach of providing ‘the right advice, in the right way and at the right time’ as the most influential feature that assisted them to address participation restrictions and support positive health outcomes. This was accomplished by the service providers acting in a coordinated and interdisciplinary manner with a clear remit to address participation restrictions alongside the traditional symptom management approach. Findings highlight the feasibility of the MDT-led early arthritis model as an approach to address participation-based restrictions as part of routine healthcare that delivers on the rheumatology guidelines and was positively regarded by both service users and service providers.Conclusion:Findings provide important insights into the role of an innovative early MDT intervention approach in addressing client-identified participation needs in early IA. This model maps onto the Irish rheumatology model of care (HSE, 2018), ‘right place, right time’ approach but importantly includes a ‘right way’ approach which is identified as influential in the effective delivery of client-focussed and client-centred care.