Research shows that Canada’s Aboriginal Peoples have three times more rheumatoid arthritis than the general population. It also tends to be more severe: less remission, more joint damage. Factors leading to this reality are related to how health care is delivered for Aboriginal Peoples.
A University of Calgary research team found that Aboriginal Peoples encounter a health-care system with a negative environment, where they tend to feel unwelcome, and ultimately dismissed. They opt to seek medical advice elsewhere – sometimes from a family doctor, but typically straight from family members. And for many reasons, it is simply hard to get to a specialty clinic.
So in January 2014, an Arthritis Society-funded study examined what would happen if we changed the model of care – by making access to a rheumatologist easy, inside a culturally safe environment. Led by the University of Calgary’s Cheryl Barnabe and Lynden Crowshoe, barriers to care were removed and opened specialty services opened right inside a local urban Aboriginal health centre.
The key: no referral required. Simply walk right in.
“Forty percent (of those who came) said it was hard to get in and see a rheumatologist,” Cheryl says. “They were having trouble getting referred or getting in, which speaks to deficiencies in the typical model of care.”
In all, 60 First Nations people came to the clinic with pain in their joints and muscles. Of 39 who consented to be part of the study, seven had undiagnosed inflammatory arthritis. Another five had inflammatory arthritis but were not being followed by a specialist. (The clinic also provided care to those with other musculoskeletal conditions like bursitis, fibromyalgia and osteoarthritis.)
Though a small sample size, it paints a stark picture – a high portion of Aboriginals had been living with chronic inflammatory arthritis and had not been receiving treatment.
The study ultimately had high patient satisfaction, though Cheryl believes that one-off clinics are not sustainable or practical in all settings. Instead, a system-wide change is needed.
“We need all providers (specialists and family doctors) to be culturally competent and arthritis competent,” she says. “There is a huge untapped potential of how people could be managed in the community.”
That potential is getting family doctors, nurses and other primary care practitioners more involved in arthritis care, particularly when it comes to Canada’s Aboriginal Peoples. Meanwhile, Cheryl says there is a critical need to ensure that rheumatologists are equipped to provide culturally competent care.
Every Canadian deserves the best possible care for their arthritis.