Background: Individuals living with rheumatic disease who are marginalized by extreme poverty and housing instability suffer dramatically worse outcomes [1,2]. Those living in Vancouver’s Downtown Eastside experience high rates of substance use disorder, mental illness, and early mortality.[3] Since 2019, the Mary Pack Arthritis Program has operated a twice-monthly Rheumatology Clinic (“the Clinic”) in partnership with the Pender Community Health Centre, an inner-city primary care unit in Vancouver, Canada. Although this Clinic has lowered barriers to accessing care, challenges remain in adherence to follow-up appointments, monitoring labwork, and sustaining DMARD therapy.

Objectives: Our study aimed to first review the Clinic’s service provision and subsequently design and pilot an intervention to improve patient engagement in the care of their rheumatic disease.

Methods: We utilized a mixed-methods approach beginning with a retrospective chart review of all patients seen at the Clinic from January 2022 until June 2025. We concurrently conducted interviews with Clinic rheumatologists, inner-city primary care physicians, and patient representatives to understand specific barriers. Based on these findings, we designed a prospective trial for patients with inflammatory arthritis referred from local inner city community health centers. The intervention included a $20 honorarium for each follow-up visit they attended with completed bloodwork as well as a Rheumatology-specific outreach service that provided personalized education, advice, and appointment reminders. The primary outcome was the rate of attendance to follow-up visits in the study group compared to historical controls. The study was approved by the UBC REB (H24-03984).

Results: Between January 2022 and June 2025, the Clinic treated 167 unique patients (Table 1). The baseline rate of attendance to follow-up visits was 52.6% overall, and 42.4% among patients with a confirmed systemic autoimmune rheumatic disease. The patient population had high rates of comorbidity: 77% had substance use disorders, while 59% had mental health disorders. Housing instability was nearly universal; 12% of patients were unhoused, while 78% lived in modular, transitional, or single-room occupancy (SRO) housing. At a planned interim analysis of the prospective study (n=9), the rate of adherence to follow-up visits was significantly improved compared to historical controls (90.5% vs 42.4%, p < 0.001). For participants who were previously patients at the Clinic, follow-up rates improved compared to personal priors (87.5% vs 43.5%, p < 0.001). No concerning safety signals were identified.

Conclusions: Standard models of care are often insufficient for marginalized populations. An intervention combining modest financial incentives and specialized outreach support may improve adherence to follow-up in this cohort.

REFERENCES: [1] Rai B. Clin Rheumatol 2022; 41(6):1653-1657.

[2] Seta R. Clin Rheumatol 2020; 40(1):413-420.

[3] Vila-Rodriquez F. Am J Psychiatry 2013; 170(12):1413-1422.

Acknowledgments: NIL.

Disclosure of Interests: None declared.