Promoting Equity in Rheumatoid Arthritis Through Treatment Guidelines: Implementation Guides for Six Populations at Risk for Inequitable Outcomes in Canada

Historically, guidelines for clinical practice are developed from evidence generated through randomized controlled trials, which recruit patients reflective of the population majority. This approach does not consider treatment effect differences, known population-group level differences in preferences for therapy, nor guideline implementation considerations for population groups at risk for intervention-based inequity.

In a collaboration between the Canadian Rheumatology Association’s Guidelines Committee and Quality Care Committee, the upcoming Rheumatoid Arthritis treatment guidelines are being informed by stakeholders, healthcare providers and patients representing six populations at risk for inequitable outcomes in Canada. The population groups included in the current focus are:

1. Rural and remote residents
2. Indigenous Peoples
3. Minority and refugee groups
4. Sex and gender groups
5. Those of low socioeconomic status
6. Frail senior populations.

Population-level considerations in patient factors, such as goals of treatment, patient beliefs and preferences, population manifestations impacting monitoring, and efficacy and safety differences; initial and ongoing management issues, including access to care, baseline testing, monitoring tests, reassessment of disease activity, loss to follow-up, and coordination of care; and medication concerns including access, storage, strategy, and adherence are being included in the evidence-to-decision process of the Rheumatoid Arthritis Guidelines update, and stand-alone implementation guides for each group are being developed.

Innovative models of care to reduce structural barriers to care, improved collaboration with primary care and other specialty care providers, stronger physician advocacy on behalf of patients, enhanced patient supports and a focus on communication and shared decision-making strategies are cross-cutting themes across population groups. Individual-population group approaches are recommended to address individual needs and realities, for example cultural competency training for physicians working with Indigenous Peoples, and trauma-informed care training for physicians working with refugee populations. Treatment guidelines will be available in Fall 2020 on the Canadian Rheumatology Association website.

Date modified:

2020-01-07