Clinical Activities

The Mary Pack Arthritis Program is a provincial program administered through the Vancouver Coastal Health Authority.  Services and programs include drug and disease monitoring clinics, multidisciplinary rehabilitation in the inpatient and outpatient setting, a young adult transition program, a rapid access clinic for diagnosis and initial treatment of rheumatoid arthritis, infusion services for biologic medications, and a 14 bed inpatient service in the G.F. Strong Rehabilitation centre.  

The physicians involved include Dr. Alice Klinkhoff, medical Director and consultant in the gold clinic and intensive outpatient rehabilitation program, Dr. John Kelsall, medical consultant in the Remicade / Tocilizumab Clinic, Dr. Ken Blocka, medical consultant in Rituximab Clinic, Dr. Andrew Chalmers, medical consultant for Cyclosporine Clinic , Dr. David Collins, rheumatologist for RA Diagnosis Clinic,  and Drs. Angela How, David Cabral and Lori Tucker, the rheumatologists for the Young Adult Rheumatic Disease (YARD) Clinic, for patients in  transition from paediatric to adult care.  There are several teaching-focused combined clinics, including two Combined Orthopedic / Rheumatology Clinics, with rheumatology consultant Dr. Graham Reid and orthopedic surgeons, Drs. Alistair Younger (specializing in foot reconstruction) and Dr. Erin Brown (specializing in the hand).  There is also the Oral Pathology in Rheumatology Clinic under Dental surgeon Dr. Bruce Blasberg, and the Combined Clinic in Dermatology with Dr. Jan Dutz, who is both a rheumatologist and a dermatologist.  

The Mary Pack program coordinates the travel of twelve Division faculty to 25 remote locations in British Columbia, for the Rheumatology Travelling Consultation Service.  This program’s goal is to provide education, consultation and treatment services to communities with populations of 5,000 which do not have a rheumatologist accessible within two hours driving time, as well as to numerous isolated First Nations communities.  Since 2008, Telehealth has been added to the travelling consultation service in Trail with Dr. Chalmers and most recently in Smithers with Dr. How.  The Mary Pack program also provides the full spectrum of educational workshops for patients, as well as physiotherapy, occupational therapy, and access to social workers and vocational counselors.  Funding of all the physician services for the Mary Pack Program is through the Ministry of Health APP program.

The Early Rheumatoid Arthritis clinic in the Mary Pack Athritis Program has a focus on triaging patients to determine early inflammatory arthritis, so that treatment can be started within the “window period”.  This clinic is staffed by Drs. David Collins, Alice Klinkhoff, Diane Lacaille and Andrew Chalmers.  This clinic is part of a Canadian network of early rheumatoid arthritis clinics and will share data for research purposes. 

Ambulatory care clinics offered at St. Paul’s Hospital include a rapid access program with Dr. John Kelsall, and the Limited Scleroderma Clinic with Dr. James Dunne.  Dr. Dunne also works with Dr. Wilcox, of the Division of Respiratory Medicine, in a Combined Lung Scleroderma Clinic, which helps in our goal to interact with other Divisions in order to promote excellence in the treatment and study of systemic rheumatic diseases.  The Lupus Clinic, directed by Dr. Jennifer Reynolds, has been operating for over a year, and is also staffed by Dr. Ken Blocka.  The Lupus Clinic continues to grow, seeing new patients referred by general practitioners as well as complicated consults from fellow rheumatologists.

There are three rheumatology rapid access clinics (RAC) designed for urgent general rheumatology referrals (vasculitis, acute inflammatory arthritis, and connective tissue diseases).  They are also a great opportunity for teaching.  Dr. Kelsall runs the RAC at St. Paul’s Hospital, Drs. John Wade, John Watterson, and Maz Badii run the RAC at VGH and Dr. Shojania runs the RAC out of Richmond Hospital.

The G.F. Strong Rehabilitation Centre’s Arthritis Unit, directed by Dr. John Watterson, offers post-operative and rehabilitative services to rheumatology patients along with specialized physiotherapy, occupational therapy and vocational counseling.  Inpatient services are offered at Vancouver Acute and St. Paul’s Hospital. Dr. Simon Huang retired from GF Strong and Dr. Raheem Kherani has joined the group.  In 2010, Dr. Raheem Kherani developed an outpatient program at GFS in order to facilitate early discharge and to optimize rehabilitation potential.

Dr. Robert Offer in Penticton has extensive involvement in teaching including rheumatology fellows, residents and medical students.  He is involved in many continuing-education events for physicians.  Penticton is the major rheumatology resource for the interior with a well-staffed Mary Pack Treatment Centre at Penticton Regional Hospital and a drug monitoring clinic covering more than 500 active rheumatoid arthritis patients.  Dr. Offer does outreach traveling consultation clinics and now telemedicine to Creston, as well as research and clinical trials. 

The pilot project in Telehealth to the Kootenays was implemented in December 2009, to enable rapid access of urgent new and previously seen patients.  The program continued successfully through 2010, and has resulted in significantly reduced wait times.  A second program to Smithers has recently been started.  Currently, the effectiveness of the Telehealth program is being compared to that of regular face to face clinics, for treatment of rheumatoid arthritis.

In conjunction with Yukon Health, Dr. Graham Reid travelled to Whitehorse four times in 2010, to provide travelling rheumatology services there for his 18th consecutive year.

Hospitals:
VGH
SPH
Mary Pack Arthritis Program
GF Strong rehabilitation