Facteurs influençant le choix du futur lieu d’exercice chez les résidents en rhumatologie

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations. Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test. Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%). Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists. Contexte : Au Canada, il existe des disparités régionales dans la répartition des rhumatologues. La présente étude recense les facteurs qui influencent les choix des résidents en rhumatologie concernant leur lieu d’exercice futur afin de guider les recommandations de Société canadienne de rhumatologie relatives aux effectifs. Méthodes : Après l’élaboration d’un sondage en ligne, une invitation a été envoyée à tous les résidents en rhumatologie au Canada en 2019 (n = 67). Les différences entre les groupes ont été examinées à l’aide du test Pearson χ2. Résultats : Trente-quatre des 67 résidents contactés ont répondu au sondage. Soixante-treize pour cent des répondants prévoyaient d’exercer dans la province où ils avaient fait leur formation en rhumatologie. La majorité des résidents (80 %) ont classé la proximité des amis et de la famille comme le facteur le plus important dans leur choix de lieu d’exercice. La moitié des participants s’étaient familiarisés avec d’autres modes de prestation de soins (par exemple, la télésanté) pendant leur formation en rhumatologie et 15 d’entre eux (44 %) avaient fait un stage en rhumatologie communautaire. Conclusions : La majorité des résidents en rhumatologie déclarent avoir l’intention d’exercer près de chez eux, dans la province où ils ont fait leurs études. Les lacunes dans la formation comportent l’exposition limitée à des stages dans les petits centres en milieu communautaire, en télésanté et dans les cliniques mobiles ciblant les populations mal desservies. Nos conclusions soulignent le besoin de stratégies visant à augmenter l’exposition des résidents en rhumatologie à des zones mal desservies afin de remédier à la mauvaise répartition géographique des rhumatologues

Safety and effectiveness of adalimumab in a clinical setting that reflects Canadian standard of care for the treatment of rheumatoid arthritis (RA): Results from the CanACT study

<p>Abstract</p> <p>Background</p> <p>This multicenter, open-label, prospective, single cohort study evaluated the effectiveness and safety of adalimumab in a clinical setting reflecting the Canadian standard of care for the treatment of patients with rheumatoid arthritis (RA).</p> <p>Methods</p> <p>Patients ≥ 18 years of age with a history of active RA ≥ 3 months and fulfilling Canadian requirements for biological therapy received adalimumab 40 mg subcutaneously every other week for 12 weeks. Pre-study DMARD treatment regimens, corticosteroids, or NSAIDs were allowed throughout the study. The primary effectiveness outcome measure was the mean change in 28-joint disease activity score (DAS28) from baseline to Week 12. Secondary measures included the proportion of patients achieving joint remission (DAS28 < 2.6) and low-disease activity (DAS28 < 3.2) at Week 12, and European League Against Rheumatism (EULAR: moderate and good) and American College of Rheumatology (ACR: ACR20, 50, and 70) responses, as well as responses in ACR core components at Weeks 4, 8, and 12. Subgroup analysis included a comparison of patients naïve to biological DMARD (BDMARD) therapy versus BDMARD-experienced patients. Safety was assessed in terms of adverse and serious adverse events.</p> <p>Results</p> <p>A total of 879 patients (mean disease duration > 12 years) were enrolled; 772 (87.9%) completed the 12-week period. Adalimumab treatment was associated with rapid and sustained improvements in the signs and symptoms of RA. Significant improvements in mean DAS28 score were observed as early as Week 4. After 12 weeks of adalimumab treatment, 15.3% and 28.9% of patients achieved clinical remission and low-disease activity, respectively. Similarly, significant improvements in ACR core components were observed as early as Week 4, with continued improvements occurring through 12 weeks. Patients naïve to BDMARD therapy demonstrated numerically greater clinical responses when compared with patients who had experienced prior BDMARD therapy, although both subgroups were associated with significant improvements from baseline. The rates and types of adverse events, as well as the results of laboratory measures, demonstrated that adalimumab was generally safe and well-tolerated.</p> <p>Conclusions</p> <p>This study demonstrated that, under conditions reflective of the normal clinical practice in Canada, adalimumab is an effective and safe treatment for patients with RA.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00649545">NCT00649545</a>.</p

Validation of the GALS musculoskeletal screening exam for use in primary care: a pilot study

<p>Abstract</p> <p>Background</p> <p>As the proportion of the Canadian population ≥65 grows, so too does the prevalence of musculoskeletal (MSK) conditions. Approximately 20% of visits to family physicians occur as a result of MSK complaints. The GALS (Gait, Arms, Legs, and Spine) screening examination was developed to assist in the detection of MSK abnormalities. Although MSK exams are primarily performed by rheumatologists or other MSK specialists, expanding their use in primary health care may improve the detection of MSK conditions allowing for earlier treatment. The primary goal of this study was to evaluate the use of the GALS locomotor screen in primary care by comparing the results of assessments of family physicians with those of rheumatologists. The secondary goal was to examine the incidence of MSK disorders and assess the frequency with which new diagnoses not previously documented in patients' charts were identified.</p> <p>Methods</p> <p>Patients ≥65 years old recruited from an academic family health centre were examined by a rheumatologist and a family physician who recorded the appearance of each participant's gait and the appearance and movement of the arms, legs and spine by deeming them normal or abnormal. GALS scores were compared between physicians with the proportion of observed (P_obs), positive (P_pos) and negative (P_neg) agreement being the primary outcomes. Kappa statistics were also calculated. Descriptive statistics were used to describe the number of "new" diagnoses by comparing rheumatologists' findings with each patient's family practice chart.</p> <p>Results</p> <p>A total of 99 patients consented to participate (92 with previously diagnosed MSK conditions). Results showed reasonable agreement between family physicians and rheumatologists; P_obs= 0.698, P_pos= 0.614 and P_neg= 0.752. The coefficient of agreement (estimated Kappa) was 0.3675 for the composite GALS score. For individual components of the GALS exam, the highest agreement between family physicians and rheumatologists was in the assessment of gait and arm movement.</p> <p>Conclusion</p> <p>Previously reported increases in undiagnosed signs and symptoms of musculoskeletal conditions have highlighted the need for a simple yet sensitive screening exam for the identification of musculoskeletal abnormalities. Results of this study suggest that family physicians can efficiently use the GALS examination in the assessment of populations with a high proportion of musculoskeletal issues.</p

Factors influencing rheumatology residents’ decision on future practice location

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations.Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test.Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%).Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists.Contexte : Au Canada, il existe des disparités régionales dans la répartition des rhumatologues. La présente étude recense les facteurs qui influencent les choix des résidents en rhumatologie concernant leur lieu d’exercice futur afin de guider les recommandations de Société canadienne de rhumatologie relatives aux effectifs.Méthodes : Après l’élaboration d’un sondage en ligne, une invitation a été envoyée à tous les résidents en rhumatologie au Canada en 2019 (n = 67). Les différences entre les groupes ont été examinées à l’aide du test Pearson χ2.Résultats : Trente-quatre des 67 résidents contactés ont répondu au sondage. Soixante-treize pour cent des répondants prévoyaient d’exercer dans la province où ils avaient fait leur formation en rhumatologie. La majorité des résidents (80 %) ont classé la proximité des amis et de la famille comme le facteur le plus important dans leur choix de lieu d’exercice. La moitié des participants s’étaient familiarisés avec d’autres modes de prestation de soins (par exemple, la télésanté) pendant leur formation en rhumatologie et 15 d’entre eux (44 %) avaient fait un stage en rhumatologie communautaire.Conclusions : La majorité des résidents en rhumatologie déclarent avoir l’intention d’exercer près de chez eux, dans la province où ils ont fait leurs études. Les lacunes dans la formation comportent l’exposition limitée à des stages dans les petits centres en milieu communautaire, en télésanté et dans les cliniques mobiles ciblant les populations mal desservies. Nos conclusions soulignent le besoin de stratégies visant à augmenter l’exposition des résidents en rhumatologie à des zones mal desservies afin de remédier à la mauvaise répartition géographique des rhumatologues

How to Attract Trainees, a Pan-Canadian Perspective: Phase 1 of the "Training the Rheumatologists of Tomorrow" Project

Objective.To identify what learners and professionals associated with rheumatology programs across Canada recommend as ways to attract future trainees.Methods.Data from online surveys and individual interviews with participants from 9 rheumatology programs were analyzed using the thematic framework analysis to identify messages and methods to interest potential trainees in rheumatology.Results.There were 103 participants (78 surveyed, 25 interviewed) who indicated that many practitioners were drawn to rheumatology because of the aspects of work life, and that educational events and hands-on experiences can interest students. Messages centered on working life, career opportunities, and the lifestyle of rheumatologists. Specific ways to increase awareness about rheumatology included information about practice type, intellectual and diagnostic challenges, diversity of diseases, and patient populations. Increased opportunity for early and continued exposure for both medical students and internal medicine residents was also important, as was highlighting job flexibility and availability and a good work-life balance. Although mentors were rarely mentioned, many participants indicated educational activities of role models. The relatively low pay scale of rheumatologists was rarely identified as a barrier to choosing a career in rheumatology.Conclusion.This is the first pan-Canadian initiative using local data to create a work plan for developing and evaluating tools to promote interest in rheumatology that could help increase the number of future practitioners.</jats:sec

Efficacy and safety of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional DMARDs in patients with RA at week 97 (SUMMACTA)

Objectives To evaluate the long-term efficacy and safety of subcutaneous (SC) tocilizumab (TCZ) versus intravenous (IV) TCZ, including switching formulations, in patients with rheumatoid arthritis (RA) and inadequate response to disease-modifying antirheumatic drugs (DMARDs). Methods Patients (n=1262) were randomised 1: 1 to receive TCZ-SC 162 mg weekly (qw)+placebo-IV every four weeks (q4w) or TCZ-IV 8 mg/kg q4w+placebo-SC qw in combination with DMARD(s). After a 24-week double-blind period, patients receiving TCZ-SC were re-randomised 11: 1 to TCZ-SC (n=521) or TCZ-IV (TCZ-SCIV, n=48), and patients receiving TCZ-IV were re-randomised 2: 1 to TCZ-IV (n=372) or TCZ-SC (TCZ-IV-SC; n=186). Maintenance of clinical responses and safety through week 97 were assessed. Results The proportions of patients who achieved American College of Rheumatology (ACR) 20/50/70 responses, Disease Activity Score in 28 joints remission and improvement from baseline in Health Assessment Questionnaire Disability Index >= 0.3 were sustained through week 97 and comparable across arms. TCZ-SC had a comparable safety profile to TCZ-IV through week 97, except that injection site reactions (ISRs) were more common with TCZ-SC. Safety profiles in patients who switched were similar to those in patients who received continuous TCZ-SC or TCZ-IV treatment. The proportion of patients who developed anti-TCZ antibodies remained low across treatment arms. No association between anti-TCZ antibody development and clinical response or adverse events was observed. Conclusions The long-term efficacy and safety of TCZ-SC was maintained and comparable to that of TCZ-IV, except for ISRs. Profiles in patients who switched formulations were comparable to those in patients who received TCZ-IV or TCZ-SC. TCZ-SC provides additional treatment options for patients with RA