Pediatric Rheumatology Care in the Canadian Context: A Qualitative Analysis of Care Providers.

Abstract

Previous work highlighted a national deficit in pediatric rheumatologists and allied health professionals (AHPs), with a geographic maldistribution in Canada. The aim of this current study was to further evaluate the clinical care structures and processes in place within Canadian pediatric rheumatology centers that promote or impede care delivery from the perspective of pediatric rheumatology healthcare providers. Data were collected through semistructured interviews with pediatric rheumatologists and Advanced Clinician Practitioners in Arthritis Care (ACPACs) across Canada. Analysis was performed by 2 investigators following the 4 stages of qualitative content analysis: decontextualization, recontextualization, categorization, and compilation. Data were analyzed through latent analysis due to the informal nature of interviews, and themes were identified iteratively. Twelve individuals (9 pediatric rheumatologists, 3 AHPs) agreed to participate in the study. Interviewees practiced across Canada with a range of career experience. The following themes emerged: (1) geographic barriers negatively affect access to care; (2) ACPAC practitioners and community pediatric rheumatologists improve access to care; and (3) there is inconsistent access to physiotherapists, social workers, and occupational therapists who are knowledgeable about pediatric rheumatology care and disease. Although there was variation in pediatric rheumatology practice across Canada, there were common themes of supports and barriers to clinical care. The description of these themes can (1) help guide pediatric rheumatology practice by highlighting thriving practice patterns, and (2) concomitantly emphasize the deficits in resources and functioning, both of which can advise future advocacy work.