Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial

SE Hewlett, JR Kirwan, JI Pollock, K Mitchell, M Hehir, PSP Blair, David S Memel, MG Perry

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Abstract

Objectives: To determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical mid psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist
Design: Two year randomised controlled trial extended to six years.
Setting: Rheumatology outpatient department in teaching hospital.
Participants: 209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04).
Main outcome measures: Clinical outcome: pain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in die system. Number of visits to hospital physician mid general,practitioner for arthritis.
Results: Participants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (All P <0.02). Patients in the direct access go-roup had 38% fewer hospital appointments (median 8 v 13, P <0.0001). years rheumatoid.
Conclusions: Over six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. The), requested fewer appointments, found direct access more acceptable, mid had more than a third fewer medical appointments. This radical responsive management could be tested in other chronic diseases.
Translated title of the contributionPatient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial
Original languageEnglish
Pages (from-to)171-175
Number of pages5
JournalBMJ
Volume330
Issue number7484
DOIs
Publication statusPublished - 16 Nov 2004

Bibliographical note

Publisher: BMJ Group.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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