Volume 206 - Issue 2
Multidisciplinary paediatric rheumatology services in Australia and New Zealand
Author: Davinder Singh-Grewal
Med J Aust 2017; 206 (2): 96-97. || doi: 10.5694/mja16.00710
Published online: 6 February 2017
Published online: 6 February 2017
Access and funding are the greatest challenges
To the Editor:
Skilled multidisciplinary team (MDT) care facilitates the best possible outcomes for children with rheumatic diseases.1-4 Yet there is a significant shortfall in MDT resources in Australia and New Zealand.5 To better understand the situation, we surveyed the 15 paediatric rheumatologists in the region, receiving 14 responses.
Eleven respondents agreed that MDT care was necessary but only half believed that it was easily available to their patients. The availability of the various specific components of the MDT in the respondents’ public and private practice settings is shown in the Box. This suggests that public settings were better equipped for the provision of MDT care. Five respondents felt that access to public services was limited. Only one considered that patients in regional areas had easy access to MDT care close to home.
Most respondents (13/14) felt that there was a need to increase MDT provision in their region and that current staff levels were inadequate to service this need; however, only two were confident that they could train staff to address this shortfall. Four thought that administrators and health service planners were aware of these deficiencies, but only one considered them to be supportive.
The greatest challenge faced by patients with rheumatic disease was deemed to be access to specialty care, particularly in the public hospital system, resulting in long waiting times and poor access to MDT care. Over a third of respondents highlighted limited outreach services to regional areas as an issue, and three listed access to intra-articular steroid injections as challenging. Not surprisingly, respondents considered funding to be the greatest barrier to establishing and maintaining MDT care.
Although our survey was small and specifically targeted, it provides insights into clinicians’ impressions of current services and future challenges. Paediatric rheumatologists clearly consider MDT care to be important but feel that it is not universally accessible. Publicly funded services were thought to be best able to provide MDT care, but access was limited and funding to develop services was seen as the most significant barrier to training staff and improving services.
Box – Multidisciplinary team availability
Multidisciplinary team member |
Private practice (n = 12)* |
Public practice (n = 14) |
|||||||||||||
Rheumatology nurse |
4 |
9 |
|||||||||||||
Physiotherapist |
6 |
10 |
|||||||||||||
Occupational therapist |
4 |
9 |
|||||||||||||
Other† |
1 |
6 |
|||||||||||||
* Two respondents were not in private practice. † For example, dietitian, social worker, psychologist. | |||||||||||||||
Competing interests
No relevant disclosures.
References
- Foster HE, Eltringham MS, Kay LJ, et al. Delay in access to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. Arthritis Rheum 2007; 57: 401-404.
- Foster H, Rapley T. Access to pediatric rheumatology care — a major challenge to improving outcome in juvenile idiopathic arthritis. J Rheumatol 2010; 37: 2199-2220.
- Graham TP Jr, Beekman RH III, Freed MD, et al. Policy statement - Organizational principles to guide and define the child health care system and/or improve the health of all children. A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence (ACC/AHA/AAP Writing Committee to Develop Training Recommendations for Pediatric Cardiology). Pediatrics 2005; 116: 263-269.
- Munro J, Murray K, Boros C, et al. Australian Paediatric Rheumatology Group standards of care for the management of juvenile idiopathic arthritis. J Paediatr Child Health 2014; 50: 663-666.
- Cox A, Piper S, Singh-Grewal D. Pediatric rheumatology consultant workforce in Australia and New Zealand: the current state of play and challenges for the future. Int J Rheum Dis 2016; doi: 10.1111/1756-185X.12802 [Epub ahead of print].