Use of Coordinator Role Improves Access to Rheumatologic Advanced Therapy.

OBJECTIVE: Delays in initiation of advanced therapies, which include biologics and targeted synthetic disease-modifying antirheumatic drugs, contribute to poor patient outcomes. The objective of this quality improvement project was to identify factors that lead to a delay in the initiation of advanced therapy and to perform plan-do-study-act cycles to decrease the time to start advanced therapy. METHODS: A retrospective chart review identified factors involved in delay to start advanced therapy. The primary outcome of the study was the number of days to advanced therapy start as measured by the date of rheumatologist recommendation to the date advanced therapy was initiated by the patient. An Advanced Therapy Coordinator role was created to standardize the workflow, optimize communication, and ensure a safety checklist was instituted. RESULTS: A total of 125 patients were reviewed for the study with 18 excluded. Preintervention median wait time was 82.0 (IQR 46.0-80.5) days. Median wait time during the intervention improved to 49.5 (IQR 34.0-69.5) days (April 2021 to January 2022), with nonrandom variation post intervention. Nonrandom variation was also noted in the latter baseline data (March 2020 to March 2021). CONCLUSION: This study demonstrates improved wait time to advanced therapy initiation through the role of an Advanced Therapy Coordinator to facilitate communication pathways.

Psychiatric medication use by Canadian adults prior to entering an outpatient eating disorders program: Types and combinations of medications, predictors of being on a medication, and clinical considerations.

This study examined the proportion of Canadian adults who were on psychiatric medication prior to entering specialized outpatient care for an eating disorder, the types and combinations of medications taken, and predictors of being on a medication. A retrospective chart review of 223 adults with an eating disorder was conducted. A large proportion of the adults (61%) had been prescribed a psychiatric medication prior to entering specialized outpatient care. Of these adults, 74.6% were prescribed one medication and 24.3% were on a combination of two or more. Antidepressant and anti-anxiety medications were the most commonly prescribed (78%), while stimulant medications (2.1%), benzodiazepines (13.7%), and antipsychotics (10.7%) were also reported. Being at a higher weight status was a significant predictor of being on a psychiatric medication at intake assessment. Adults with comorbid depression were 2.68 times more likely to be on a psychiatric medication. Although the number of Canadian adults on psychiatric medication may well exceed the documented efficacy of these medications for eating disorders, psychopharmacological intervention could have been aimed at targeting comorbid conditions. Clinicians specializing in pharmacology and eating disorders may have an important role to provide psychoeducation to all providers.