A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial

Abstract

BackgroundRecommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients’ disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.MethodsPatients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.ResultsA total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated €14107.7 per patient in the NLC compared with €16274.9 in the RCL (p = 0.004), giving a €2167.2 (13 %) lower annual cost for the NLC.ConclusionsPatients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.Trial registrationThe trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.

A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK

“…Results provide robust evidence to support nurse-led clinics in the management of Rheumatoid Arthritis and co-morbidity detection with nurse-led clinics having higher 'general satisfaction' than physician-led clinics [5]. The findings of the UK multi-centre RCT were consistent with those from the only other large scale costs study -in the Netherlands -which demonstrated nurse-led clinics produced equivalent outcomes at lower unit cost [6,7] Recent work in Sweden also showed that patients undergoing biological therapy can be safely monitored more cost-effectively by a nurse-led Rheumatology clinic [8,9].…”

The Asia‐Pacific Initiative for Rheumatology Nurse Education: Current gaps, programme development and future outlook

“…In Europe, nurse‐led care (NLC) was superior to general practitioner or rheumatologist‐led care (RLC) in terms of cost‐effectiveness and improvements in patient education and satisfaction without compromising clinical outcome (Doherty et al, 2018; Hill, Lewis, & Bird, 2009; Larsson et al, 2015; Ndosi et al, 2014; Primdahl, Sorensen, Horn, Petersen, & Horslev‐Petersen, 2014; Sorensen, Primdahl, Horn, & Horslev‐Petersen, 2015). Consistent with these findings, two recent studies in China comparing NLC and RLC among RA patients showed that NLC was superior in improvement of clinical outcomes and disease symptoms, more cost‐effective and led to greater patient satisfaction (Wang et al, 2017; Wang et al, 2018).…”

Effectiveness of nursing consultations in people with rheumatoid arthritis: systematic review

“…Noutro documento de consenso desta mesma entidade reforça-se a importância de se promover a educação da pessoa, que a capacite, nomeadamente para a autogestão, com consequente melhoria na adesão terapêutica (Zangi et al, 2015), atividade em boa parte do domínio dos enfermeiros e de outros profissionais de saúde. Este modelo de cuidados tem, paralelamente, demonstrado contribuir para a redução de custos dos cuidados a pessoas com doença músculo-esquelética (Koksvik et al, 2013;Larsson, Fridlund, Arvidsson, Teleman, & Bergman, 2014;Larsson et al, 2015). Vários países europeus, como por exemplo o Reino Unido, Holanda, Dinamarca, Suécia, ou Noruega, possuem já perfeitamente implementadas as CE, designadamente nesta área, com resultados publicados.…”