Development of Canadian Recommendations for the Management of ANCA-Associated Vasculitides: Results of the National Needs Assessment Questionnaire



Leilani Famorca 1, Marinka Twilt 2, Lillian Barra 3, Volodko Bakowsky 4, Susanne Benseler 5, David Cabral 6, Simon Carette 7, Navjot Dhindsa 8, Aurore Fifi-Mah 9, Michelle Goulet 10, Nader Khalidi 11, Majed Khraishi 12, Lucy McGeoch 7, Nataliya Milman 13, Christian Pineau 14, Kam Shojania 15, Regina Taylor-Gjevre 16, Tanveer Towheed 17, Judith Trudeau 18, Elaine Yacyshyn 19, Patrick Liang 20, Christian Pagnoux*, 7, for the Canadian Vasculitis network (CanVasc)
1 Langs Community Centre, Cambridge, Ontario, Canada
2 Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
3 Division of Rheumatology, St. Joseph’s Health Care, London, Ontario, Canada
4 Division of Rheumatology, Nova Scotia Rehabilitation Center, QEII HSC, Halifax, Nova Scotia, Canada
5 Division of Rheumatology, Department of Paediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
6 Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia, Canada
7 Department of Rheumatology, Mount Sinai Hospital, Toronto, University of Toronto, Ontario, Canada
8 Section of Rheumatology, University of Manitoba, Arthritis Centre, Winnipeg, Manitoba, Canada
9 Division Division of Rheumatology, South Health Campus, University of Calgary, Calgary, Alberta, Canada
10 Division of Internal Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
11 Division of Rheumatology, St. Joseph's Healthcare Hamilton, McMaster University Hamilton, Ontario, Canada
12 Division of Rheumatology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
13 Arthritis Centre at the Ottawa Hospital, Riverside Campus, Ottawa, Ontario, Canada
14 McGill University, MUHC Lupus and Vasculitis clinic, Montréal, Québec, Canada
15 Division of Rheumatology, Vancouver General Hospital and St. Paul's Hospital, Vancouver, British Columbia, Canada
16 Division of Rheumatology, Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
17 Department of Medicine, Queen's University, Kingston, Ontario, Canada
18 Division of Rheumatology, CHAU de Lévis, Lévis, Quebec, Canada
19 Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
20 Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada


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© Famorca et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Mount Sinai Hospital, The Joseph and Wolfe Lebovic Building, R 2-220, 60 Murray Street, Toronto, ON, M5T 3L9, Canada; Tel: +1-416-586-4800, Ext. 8549; Fax: +1-416-586-8766; E-mail: cpagnoux@mtsinai.on.ca
§ A complete and updated list of CanVasc founders, bureau, core, associated and affiliated members can be downloaded from: http://www.canvasc.ca/InformationCanVasc.htm.


Abstract

Objectives :

To study variations in Canadian clinical practice patterns for the management of ANCA-associated vasculitis (AAV) and identify points to consider for the development of national recommendations.

Material and Methodology :

A 30-item needs assessment questionnaire was sent to all members of the Canadian Vasculitis network (CanVasc), Canadian Rheumatology Association (CRA), Canadian Thoracic Society (CTS) and Canadian Society of Nephrology (CSN). Respondent characteristics, practice patterns, concerns and expectations were analyzed.

Results :

Among 132 physicians who followed at least 1 vasculitis patient and responded to the survey, 39% stated that they felt confident in their management of AAV. Several variations in practice were observed regarding diagnostic procedure, induction and maintenance treatments and use of biologics; some were due to logistic constraints (difficulties in access to some specific tests, drugs or care; lack of health care coverage for the costs). The top 5 topics for which recommendations are expected involve treatment for remission induction, maintenance, refractory disease, and relapse as well as biologics.

Conclusion :

Practice variations identified in this needs assessment survey will serve to formulate key questions for the development of CanVasc recommendations.

Keywords: ANCA-associated vasculitis, CanVasc, physician practice patterns.