Background: To improve how inflammatory arthritis (IA) care is delivered in Canada and the outcomes obtained, we are co-designing FlexCAre in partnership with adults living with IA and health care providers. FlexCAre aims to better meet the individual needs of patients and achieve better health outcomes.

Objectives: We conducted focus groups two primary groups of stakeholders to learn about their experiences, values and preferences, to inform the timing, modality, and nature of healthcare visits to optimize IA care: 1) adults with inflammatory arthritis (IA) across Canada; and 2) Canadian IA health care providers (HCPs).

Methods: Separate online focus groups were held with adults with IA and HCPs treating RA in English and French drawn from across Canada. The structured online groups lasting 90 minutes used predefined questions to explore how IA care delivery could be optimized in the post-COVID era to better meet their needs and improve IA care delivery. Transcripts were thematically coded by the research team members and analysed separately and then together to identify patterns to inform new approaches, interventions, and policy.

Results: The 42 adults participating in Patient Focus Groups (English n=30); French n=12) had a mean (SD) age of 64 (13) years and disease duration of 9 (15) years. They were mostly white (88%) women (88%) from the provinces of British Columbia (21%), Alberta (10%), Ontario (29%), Quebec (36%) and Nova Scotia (5%) living in urban locations (60%) across Canada. Most had RA (50%), PsA (14%), axSpA (10%), and/or other rheumatic diseases (26%). The 30 HCPs had a mean (SD) age of 64 (13) years. They included rheumatology nurses (67%), rheumatologists (30%) and pharmacists (3%) in BC (60%) and AB (40%) who had been practicing on average 16 years. Three overarching themes were identified from the patient focus groups: 1) IA affects all aspects of life. Participants described the physical, mental, and social burden of IA and need for co-ordinated, holistic care – ideally at one site. They regarded nurses as essential valued team members providing clinical and psychosocial support. 2) Information needs are dynamic and often go unmet. Patients reported limited preparedness for managing their IA and have difficulty accessing timely, relevant information. They identified opportunities for improved education through online and direct engagement with different rheumatology team members. 3) Care must be individualized. Health care needs and preferences vary based on disease activity and duration, life context, and social determinants. They discussed the need to take into consideration individual circumstances and preferences in addition to results of between-visits remote monitoring.

Three overarching themes were identified from the focus groups with HCPs: 1) The challenge of providing whole person care. HCPs noted that when patients lack access to primary care, providing whole person care can feel overwhelming and limits their ability to focus on complex, dynamic disease-specific needs. Equity gaps are greatest among older adults, racialized groups, individuals with mobility limitations, and in rural areas. Unrealistic patient expectations regarding the scope of services rheumatologists can offer were noted, particularly when patients lack a family doctor and/or mental health services. 2) The need for education and support from IA interprofessionals. Sustaining interprofessional teams remains challenging, even with provincial funding. HCPs emphasized the value of rheumatology team members to educate patients and fill gaps by providing virtual visits, responding to messaging systems, and returning calls. 3) Individualizing care through flexible tools and strategies. HCPs varied in their use of and preferences for virtual care and between-visit monitoring, tailoring approaches to patient needs, disease status, and life context. Flexibility regarding visit scheduling, type, and monitoring was deemed essential. Several noted that when medication approval depends on symptom assessments, patients are more likely to complete questionnaires. E-health systems can provide disease education and self-management skills training.

Conclusions: Advances in newer IA treatment and access to virtual and specialized interprofessional arthritis care have significantly improved IA outcomes for many adults in Canada, but important gaps persist. Patinents and HCPs working in IA identified key challenges and opportunities to improve IA care delivery. While physical aspects of IA can be controlled, important gaps persist with emotional and social health needs. Findings underscore the importance of flexible, integrated, and patient-centered approaches to meet diverse needs, support whole person care, and reduce the burden on providers and meet patient needs. These results are being used to inform the development and initial testing of FlexCAre, a new IA care model that integrates education, remote monitoring, and flexible visit schedules to better meet the diverse needs of individuals with IA. A patient-informed approach has the potential to improve engagement, equity, and outcomes in Canadian IA care.

REFERENCES: NIL.

Acknowledgments: NIL.

Disclosure of Interests: Susan J. Bartlett Fresenius Kabi, Janssen, Merck, Novartis, Organon, Sandoz, Sandoz, Nordic, Nadia Deville-Stoetzel: None declared, Emilie McGuire: None declared, Kayli Raptis: None declared, Deborah DaCosta: None declared, Diane Lacaille: None declared.