Sarah Hewlett Sarah.Hewlett@uwe.ac.uk
Patient-initiated hospital follow-up for rheumatoid arthritis
Hewlett, Sarah; Kirwan, John R.; Mitchell, K; Hogg, J; Korendovych, E; Paine, T
Authors
John R. Kirwan
K Mitchell
Julie Taylor Julie6.Taylor@uwe.ac.uk
Associate Lecturer - CHSS - HSW - UHSW0001
E Korendovych
T Paine
Abstract
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.
Journal Article Type | Article |
---|---|
Publication Date | Jan 1, 2000 |
Journal | Rheumatology |
Print ISSN | 1462-0324 |
Electronic ISSN | 1462-0332 |
Publisher | Oxford University Press (OUP) |
Peer Reviewed | Peer Reviewed |
Volume | 39 |
Pages | 990-997 |
Keywords | rheumatoid arthritis, hospital follow-up, patient-initiated, cost, pain, disability, self-efficacy, satisfaction |
Public URL | https://uwe-repository.worktribe.com/output/1095363 |
Publisher URL | http://rheumatology.oxfordjournals.org/cgi/content/short/39/9/990 |
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