In patients with juvenile idiopathic arthritis (JIA), the use of a national, legally mandated universal access program — for example, the Explicit Health Guarantees (GES) in Chile — may ensure that assessment by a specialist occurs less than 30 days following referral from primary care and that treatment be initiated at 7 days or fewer after a confirmed JIA diagnosis, according to an editorial published in The Journal of Rheumatology.
According to the authors of the editorial, the GES is aiming to address the numerous challenges involved in access to rheumatology care in the developing world, particularly among the pediatric population. Issues include a lack of awareness of arthritis and other autoimmune diseases in childhood, along with limited availability of pediatric rheumatology services. The GES plan addresses some of the key objectives for improvement that have been described by the Institute of Medicine’s framework for health care quality, which includes safe care; timely access to care; effective care; efficient care; equitable care; and patient-centered care.
Among patients with JIA, care was considered to be safe with the implementation of the GES program because it guaranteed access to ophthalmology care for children diagnosed with JIA, thus avoiding the possibility of a missed diagnosis of uveitis. The GES program was responsible for significantly reduced rates of uveitis complications, including a decrease in partial loss of vision from 36% to 4%. Improved access to the use of magnetic resonance imaging (MRI) was observed as well, with a marked increase in the numbers of MRIs performed, thus enabling earlier and more accurate JIA diagnoses.
Another key mandate of the GES was equitable care, with the program given free of cost to individuals of low socioeconomic status with public insurance. For example, patients will have access to rehabilitation, including occupational therapy and physiotherapy, regardless of their income. This will help children with JIA get access to a full multidisciplinary team whose members have the appropriate expertise and skills to manage these patients. Members of a core multidisciplinary team should include pediatric rheumatologists, pediatric rheumatology clinical nurse specialists, ophthalmologists, general practitioners, pediatric physiotherapists, pediatric clinical psychologists, pediatric occupational therapists, podiatrists, and health visitors or school nurses.
According to the authors of the editorial, the GES is working toward guaranteeing patients with JIA with access for life and ensuring that patients are equipped to transition to adult care.
The authors concluded that this universal access program has contributed to increased awareness of JIA. They also noted, “Timely access to initial and ongoing ophthalmic care by a provider with expertise in uveitis and access to a full [multidisciplinary team] with expertise in JIA remain important unmet needs in both the developing and developed world.”
Berard R, Batthish M. Addressing healthcare quality in juvenile idiopathic arthritis with a universal access program. J Rheumatol. Published online August 1, 2021. doi:10.3899/jrheum.210658