For clinicians

ACPAC extended-role practitioners

ACPAC-ERP, extended role practitioner, advanced practice

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Bottom lineThe Advanced Clinician Practitioner in Arthritis Care (ACPAC) program (University of Toronto; hosted at St. Michael's for adults, SickKids for paediatrics, with the Schroeder Arthritis Institute at UHN) trains experienced PTs, OTs, nurses, and chiropractors as extended-role practitioners who triage, assess, educate, monitor, and co-manage rheumatic and musculoskeletal disease with rheumatologists, often under medical directives. It is a strong Canadian model, presented here alongside nurse-led and other advanced-practice models rather than as the only approach.

The model in practice

What an extended-role practitioner does ●●●○moderate evidenceconditional

ACPAC-ERPs work in two streams: triage of suspected inflammatory arthritis, and ongoing collaborative management. They perform advanced assessment, order and interpret investigations within their scope, educate, and escalate per agreed directives.[1, 3]

How it improves access to care ●●●○moderate evidenceconditional

A co-management model gave one saturated senior rheumatology practice a 37% increase in new-patient capacity while maintaining equivalent patient satisfaction and confidence, with lower perceived disability in co-managed patients. System-level data show timely access through triage under medical directives.[2, 3]

Working with your rheumatologist ●●○○low evidenceconditional

Care is collaborative and directive-based; the rheumatologist retains oversight. Telerheumatology hub-and-spoke models extend this into rural and remote settings with measurable access and travel-cost benefits.[2, 4]

In pregnancy and family planning ●●○○low evidenceconditional

In reproductive rheumatology, the extended-role practitioner can support pre-conception planning, structured education, allied-health optimisation, triage of red flags in the pregnant or planning patient, and escalation to rheumatology or maternal-fetal medicine. This specific application is under-described and is a genuine development opportunity.[1]

One model among several ●●○○low evidenceconditional

ACPAC-ERPs are Canada's homegrown model and this clinic's local anchor, but nurse-led clinics, nurse practitioners, physician associates, and clinical nurse specialists deliver comparable coordinated care elsewhere. Global leadership means presenting the whole family of models and being honest that the best fit depends on workforce, regulation, and funding.[1]

Key points

PointEvidence
Co-management increased new-patient capacity by 37% in one saturated practice with equivalent satisfaction and confidence (Ahluwalia et al. 2021).[2]●●●○moderate evidenceconditional
The model is non-exclusive: nurse-led, NP, PA, and CNS models are equally legitimate approaches to coordinated reproductive rheumatology care.[1]●●○○low evidenceconditional

References

  1. Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program. University Health Network / University of Toronto. https://www.uhn.ca/Arthritis/education/Pages/acpac-program.aspx
  2. Ahluwalia V, et al. An ACPAC-trained Extended Role Practitioner Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care. J Multidiscip Healthc. 2021;14:1299-1310. https://pubmed.ncbi.nlm.nih.gov/34113118/
  3. Passalent LA, et al. System Integration and Clinical Utilization of ACPAC-Trained Extended Role Practitioners in Ontario. Healthc Policy. 2013. https://pubmed.ncbi.nlm.nih.gov/23968638/
  4. Telerheumatology Shared-Care Model Leveraging an ACPAC-Trained Extended Role Practitioner in Rural-Remote Ontario. J Rheumatol. 2024;51(9):913. https://www.jrheum.org/content/51/9/913