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Ziade N, Hmamouchi I, Haouichat C, Baron F, Al Mayouf S, Abdulateef N, Masri B, El Rakawi M, El Kibbi L, El Mashaleh M, Elzorkany B, Al Saleh J, Dejaco C, Abutiban F. The rheumatology workforce in the Arab countries: current status, challenges, opportunities, and future needs from an ArLAR cross-sectional survey. Rheumatol Int 2023; 43:2281-2292. [PMID: 37624401 DOI: 10.1007/s00296-023-05427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
The Arab League of Associations for Rheumatology (ArLAR) Research Group (ARCH) conducted this study to investigate the number of current practicing rheumatologists in the Arab countries, to estimate the projected number of rheumatologists in 10 years, and to evaluate the current workload, practice profile, consultation waiting time, and geographical mobilities of these rheumatologists. This cross-sectional survey study was conducted in 16 Arab countries in two parts. The first survey was addressed nominally to national societies to estimate the current and projected workforce. The second was an anonymous e-survey elaborated by the study steering committee on the Google Forms platform and distributed to Arab rheumatologists using social media, WhatsApp, and mass e-mails to evaluate their practice. The mean number of rheumatologists in Arab countries was 0.84 per 100,000 inhabitants (mean age 47.5 years, 55% females), ranging from 0.06 (Sudan) to 1.86 (Tunisia). The number of rheumatologists is expected to increase by 50% in 2032. Nevertheless, a 20% increase in population associated with an increase in demand is also expected. Data from 446 rheumatologists (mean age 43.9 years, 60.5% females) revealed that 72% worked full-time, and 53% were employed in the public sector only. The average waiting time for a rheumatology consultation was 19.9 days. Of 394 rheumatologists, 19% obtained their rheumatology diplomas from non-Arab countries, and 47% of Gulf rheumatologists were non-citizen physicians. Considering local demographic disparities, healthcare system differences, and geographical mobilities, national authorities are advised to implement effective intervention plans to optimize the rheumatology workforce.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.
- Tour Des Consultations Externes, Hotel-Dieu de France Hospital, 6th Floor, Alfred Naccache blvd., Achrafieh, Beirut, Lebanon.
| | - Ihsane Hmamouchi
- Laboratory of Clinical Research and Epidemiology, Faculty of Medicine, Mohammed V University, Rabat, Morocco
- Department of Medicine, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Chafika Haouichat
- Rheumatology Department, Djillali Bounaama University Hospital, Douera, Algeria
- Rheumatology Department, Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Fatemah Baron
- Unit of Rheumatology, Internal Medicine Department, Al-Jahra Hospital, Ministry of Health, Kuwait City, State of Kuwait
| | - Sulaiman Al Mayouf
- Division of Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center. College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Basel Masri
- Rheumatology Division, Department of Internal Medicine, Jordan Hospital and Medical Center, Amman, Jordan
| | - Manal El Rakawi
- Rheumatology Department, Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Manal El Mashaleh
- Rheumatology Division of Internal Medicine, King Hussein Medical Center, Royal Medical Services, Jordan Armed Forces, Amman, Jordan
| | | | | | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Brunico, Italy
| | - Fatemah Abutiban
- Unit of Rheumatology, Department of Internal Medicine, Jaber Alahmed Hospital, Ministry of Health, Kuwait City, State of Kuwait
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Barnett R, Clarke C, Sengupta R, Rouse PC. Protocol for a systematic literature review of smartphone apps to support the self-management of rheumatic and musculoskeletal diseases: development strategies, theoretical underpinnings and barriers to engagement. Syst Rev 2023; 12:129. [PMID: 37516896 PMCID: PMC10385957 DOI: 10.1186/s13643-023-02276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs. METHODS Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement. DISCUSSION The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359704.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Bath, UK.
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Improving access to care for rheumatology services in Canada. Clin Rheumatol 2023; 42:1205-1211. [PMID: 36746833 PMCID: PMC9901822 DOI: 10.1007/s10067-023-06532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Rheumatic diseases are becoming increasingly prevalent in Canada, and its associated strain on the healthcare system is expected to increase over the next decades. Furthermore, there is an increasing body of evidence to suggest that access to rheumatology care is currently not meeting established quality of care benchmarks. To frame issues affecting access to care for rheumatology services in Canada, a proposed chronological framework from a rheumatology patient's perspective is proposed. Illustrating principles from a health policy lens including drawing from the stages heuristic framework and multiple streams theory, issues surrounding access to rheumatology assessment, to rheumatological investigations and lastly to appropriate treatment are explored. In particular, the current supply and demand mismatch within the rheumatology workforce presents challenges for patients in accessing rheumatic diseases providers. Potential policy solutions including increasing the pool of rheumatic diseases care providers, enhancing the clinical capacity with extended role providers and increasing uptake of virtual care are discussed. To ameliorate access to rheumatology investigations, the concept of provider education surrounding the appropriateness of investigations and merit-based funding are explored. Lastly, access to rheumatological treatment is framed using biologic therapies as an example, highlighting the policy challenges in biosimilar uptake and associated ethical and political considerations. By using a health policy lens to explore deficiencies within Canada's current system, the overarching goal of this analysis is to set the stage for reasoned and timely solutions in the future.
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Ziade N, Hmamouchi I, El Kibbi L. Women in Rheumatology in the Arab League of Associations for Rheumatology Countries: A Rising Workforce. Front Med (Lausanne) 2022; 9:880285. [PMID: 35755056 PMCID: PMC9218198 DOI: 10.3389/fmed.2022.880285] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background An increase in women physicians in the medical workforce is witnessed in recent decades, paralleled by an increase in leadership positions and, to a lesser extent, in academic advancement. Objectives This study aims to evaluate the women rheumatologists (WR) workforce and to identify the challenges faced by WR in the Arab League of Associations for Rheumatology (ArLAR) countries. Methods We collected data from members of special interest groups from 16 ArLAR countries about the number of rheumatologists in the national societies and boards – including WR –, and the estimated percentage of WR involved in academia. Also, a sample of WR was identified based on their established leadership positions and invited to a structured interview addressing their career path and the gender-related challenges. Results The proportion of WR varied widely across the ArLAR countries, with a mean of 56%. Moreover, WR constituted 47% of the society’s board members and roughly 49% of WR were involved in academia. However, only 37% of the current society presidents were females. Structured interviews indicated that WR place a high value on patient care and teaching, followed by research and publications. The primary reported gender-related challenge was balancing work with family demands. Moreover, some WR reported gender-related discrimination incurred by colleagues, patients, and administrations. Conclusion WR constituted more than half of the current rheumatology workforce in the ArLAR countries, with a lower – but steadily growing – proportion of WR in leadership positions. As they embrace their growing role in the workforce, WR must benefit from all the provided tools, from learning from the experience of current women leaders in the field to using the latest technology such as social media platforms to empower them to reach gender equity.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Hôtel-Dieu de France Hospital, Saint Joseph's University, Beirut, Lebanon
| | - Ihsane Hmamouchi
- Rheumatology Unit, Temara Hospital, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Lina El Kibbi
- Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
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Shamis J, Widdifield J, Batthish M, Mahendira D, Jamal S, Cividino A, Lethebe BC, Barber CE. Factors influencing rheumatology residents' decision on future practice location. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e63-e68. [PMID: 33995721 PMCID: PMC8105565 DOI: 10.36834/cmej.70348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents' postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations. METHODS An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test. RESULTS A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%). CONCLUSIONS The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists.
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Affiliation(s)
- Justin Shamis
- Division of Rheumatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Jessica Widdifield
- Sunnybrook Research Institute, ICES, and Institute of Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Ontario, Canada
| | - Dharini Mahendira
- Division of Rheumatology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Shahin Jamal
- Division of Rheumatology, Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Alfred Cividino
- Division of Rheumatology, Department of Medicine, McMaster University, Ontario, Canada
| | - B Cord Lethebe
- Clinical Research Unit, University of Calgary, Alberta, Canada
| | - Claire E Barber
- Division of Rheumatology, Department of Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
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