At UHN, we strive to deliver Compassionate Care & Caring. Learn more about the services and supports that are available to you throughout your journey.
Our UHN programs and services are among the most advanced in the world. We have grouped our physicians,
staff, services and resources into 10 medical programs to meet the needs of our patients and help us make
the most of our resources.
At the heart of everything we do at UHN are our Healthcare Professionals. Refer a patient to one of our 12 medical programs. Learn more about the resources and opportunities available for professional growth.
University Health Network has grown to be one of the largest research and teaching hospital networks in Canada - pioneers in improving the lives of patients. Our long history of health professions education at Toronto General, Toronto Western, Princess Margaret and Toronto Rehab hospitals has consistently advanced the science of education.
University Health Network is a health care and medical research organization in
Toronto, Ontario, Canada. The scope of research and complexity of cases at UHN has made us a national and international
source for discovery, education and patient care.
Being touched by illness affects us in different ways. Many people want to give back to the community
and help others. At UHN, we welcome your contribution and offer different ways you can help so you can find one that suits you.
The Newsroom is the source for media looking for information about UHN or trying to connect with one
of our experts for an interview. It's also the place to find UHN media policies and catch up on our news stories, videos, media releases,
podcasts and more.
UHN researchers have found a way to shorten diagnostic wait times for patients with axial spondyloarthritis. The strategy involves a two-step screening process that occurs before patients see a rheumatologist.
Axial spondyloarthritis is a form of arthritis that primarily affects the spine and sacroiliac joint near the hip, causing lower back pain and stiffness. The condition is diagnosed by a rheumatologist based on the presence of persistent back pain and joint damage.
"Due to the shortage of rheumatologists in Canada, patients with this condition typically wait years between meeting with a primary care physician and receiving a formal diagnosis," explains Dr. Yoga Raja Rampersaud, a clinician investigator at UHN's Schroeder Arthritis Institute and senior author of the study.
In response to the long wait times for rheumatology care, Dr. Rampersaud's team examined a patient screening approach that draws on experts other than rheumatologists. First, standard screening is carried out by a primary care physician. Then, secondary screening is carried out by an advanced practice clinician – a healthcare provider who is not a rheumatologist but is trained in arthritis care.
"Rheumatologists receive a high volume of referrals for patients with lower back pain, and many of these patients do not actually require specialized care," says Dr. Rampersaud. "We examined whether advanced practice clinicians can reduce diagnostic delays by better triaging patients.
"We also examined whether these advanced-practice clinicians can identify patients with axial spondylarthritis as effectively as rheumatologists."
The researchers tested the screening process in more than 400 patients. All patients were initially screened by a primary care physician. Patients who had experienced lower back pain for least three months or more, beginning before they were 50 years of age, met the criteria for further screening.
The secondary, more detailed screen was conducted by an advanced practice clinician at the Spondylitis Program at Toronto Western Hospital. Following the screening process, patients were referred to a rheumatologist for formal assessment and diagnosis.
The researchers found that the two-step screening process reduced the overall time between pain onset and diagnosis. They also found an 82.7 per cent agreement between disease assessments made by the advanced practice clinicians and those made by the rheumatologists.
"Our findings revealed that this two-step screening process can speed up diagnosis by quickly identifying patients who are most in need," says Dr. Rampersaud.
"These patients often spend months or years bouncing around the system before seeing the right provider, unfortunately too late. This networked team approach can be easily used to improve access to the right care in other forms of arthritis and other conditions.
"By drawing on physiotherapists from the Spondylitis Program at Toronto Western Hospital, we were able to speed the detection and management of arthritis, and unlock an important pathway to improved patient outcomes."
This work was supported by the Arthritis Society and UHN Foundation. C Bombardier holds a Tier 1 Canada Research Chair in Knowledge Transfer for Musculoskeletal Care.
Read more about the study