Rheumatology 2000; 39: 990-997
© 2000 British Society for Rheumatology
Patient-initiated hospital follow-up for rheumatoid arthritis
Rheumatology Unit, University of Bristol Division of Medicine, Bristol Royal Infirmary and
1 The Family Practice, Western College, Bristol, UK
Objectives. To evaluate the clinical efficacy, cost and acceptability of a shared care system of patient- or general practitioner (GP)-initiated hospital review in rheumatoid arthritis (RA).
Methods. A 2-yr randomized controlled trial of routine rheumatologist-initiated review was compared with a shared care system. Shared care patients had no routine follow-up but patients or GPs initiated access to rapid review by the multidisciplinary team via a nurse-run helpline. Control patients had a rheumatologist-initiated medical review at intervals of 3–6 months. Clinical and psychological status, resource use, and patient and GP satisfaction and confidence were assessed. Three-monthly clinical data were assessed (blind) for safety monitoring, with failure set at a 20% increase in pain, disability or disease activity.
Results. Two hundred and nine established RA patients participated, of whom 182 were evaluable. Safety-net failures were not different between groups. Shared care patients had less pain (24 months, 3.9 cm on a 10-cm visual analogue scale vs 4.8 cm for controls; P < 0.05), a smaller increase in pain over 2 yr (+ 0.4 cm vs +1.6 cm for controls; P < 0.01), greater self-efficacy (6, 15, 18, 21 months, P < 0.05), used 33.5% less resources (£208 per patient per year vs £313 for controls; P < 0.001) and were more confident in the system (6, 9, 12, 18, 21, 24 months, P < 0.01 to P < 0.001).
Conclusions. A patient-initiated system for hospital review over 2 yr offers some clinical benefit compared with the traditional system, using fewer resources and attracting greater patient confidence. Longer-term assessment of the system would be appropriate.
KEY WORDS: Rheumatoid arthritis, Hospital follow-up, Patient-initiated, Cost, Pain, Disability, Self-efficacy, Satisfaction
Correspondence to: S. Hewlett, Rheumatology Unit, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
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