Rheumatologie: Aktuelle Forschung
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An Innovative Canadian Solution for Improved Access to Care for Knee Injuries Using “Non-Physician Experts”: The Calgary Acute Knee Injury Clinic

Nicholas Mohtadi, Denise S Chan, Breda H Lau and Mark R Lafave

There is a significant burden of musculoskeletal (MSK) disorders on the Canadian healthcare system which emphasizes the need for improved patient flow and integrated services throughout the MSK clinical care pathway. Improving accessibility, effectiveness, acceptability and efficiency of safe and appropriate care of MSK health using innovative models of healthcare delivery has become an important issue for Canada. This paper is a prospective study that describes and evaluates an evidence-based model for management acute knee injuries in Calgary, Alberta, Canada: the Calgary Acute Injury Knee Clinic model (C-AKIC). C-AKIC model development consisted of three stages: 1) development, implementation and evaluation of a new non-physician expert (NPE) curriculum; 2) identification of the logistics for opening the C-AKIC within an urban setting; and 3) evaluation of the accessibility, effectiveness, acceptability and efficiency of the C-AKIC model relative to the current healthcare system. NPE curriculum improved both theoretical knowledge (12% average increase) and clinical competence (33.5% average increase). NPEs evaluated and managed acute knee injuries in an interdisciplinary team (2 NPEs and a primary care physician) at the C-AKIC. Patients were significantly more satisfied with the new clinical care pathway (M = 91.20 out of 100) compared to patients who went through the existing/traditional pathway (M = 75.58 out of 100). Patients also saw fewer healthcare providers in C-AKIC clinical care pathway (M = 2.14) in a shorter period of time (M = 2.09 months) compared to the existing system: M = 2.76 months and; M = 7.24 months, respectively. This project demonstrated a unique and efficient approach to evaluation and management acute knee injuries in an urban setting by providing a potentially viable solution to the need for human resources in the healthcare workforce.