Patient-initiated appointments compared with standard outpatient care for rheumatoid arthritis: a randomised controlled trial

Abstract

ObjectivesTo test the hypothesis that implementing a patient-initiated system of care could improve clinical outcome in rheumatoid arthritis (RA) using disease activity guided management.MethodsAn 18-month controlled blinded end point two-centre study with 131 patients with RA randomised to intervention (n=64) or control (n=67). The intervention group participants were guaranteed appointments to a rheumatologist within 10 working days if they subjectively experienced a flare in disease activity. The control group participants were booked in advance according to guidelines. Independent assessments were performed in the two groups at 0, 3, 6, 12 and 18 months. Outcome measures included: Disease Activity Score 28 (DAS28), a Visual Analogue Scale (satisfaction with care, confidence in care), number of appointments with a rheumatologist.ResultsDAS28 decreased. Median satisfaction and confidence in care were >90 mm on Visual Analog Scale. Median number of appointments was 3. There were no significant differences between the groups among these outcomes. Visits in the intervention group more often resulted in change of treatment than in the control group (p<0.001).ConclusionsPatient-initiated care was neither better nor inferior to traditional care in terms of outcomes analysed. Patient-initiated appointments can safely be used in everyday outpatient care of RA to empower the patient, if disease activity guided management is applied. Further research should investigate if this intervention can target a subgroup of patients and hence also result in released resources.

Coproduction: when users define quality

“…In settings such as forestry and fishing, she showed that coproduction led to lower costs because it was a more efficient way to meet social and community needs. 21 Similar efficiencies are reported when coproduction is implemented in healthcare settings such as serious illness, 20 palliative care, 22 mental health, 23 rheumatology 24 and primary care. 25 Efficiency is particularly true where patients learn to self-manage complex processes such as dialysis (box 2), and for example parents who learnt how to do intravenous therapy at home for infection in cystic fibrosis saved an estimated 2000 hospital days per year at the Karolinska Institute (Andreas Hagar, 2018, personal communication).…”

“…The vertical line indicates when all rheumatologists in Gävle County used the coproduction dashboards, and demonstrates a clear additional improvement. 24 …”

Patient focused registries can improve health, care, and science

“…Secondly, he developed a new delivery model that they call an "open-tight" system. 24 In effect, patients were encouraged to use the dashboards at home to track outcomes and determine if they were in remission. If they were doing well, they were "open" to visit their physicians but making a visit was up to them.…”

Patient-Initiated Follow-Up (PIFU) as reorganized support for increased patient involvement – focus group discussions among patients’ with inflammatory arthritis

“…PIFU with nurse involvement is found to be comparable to or better than traditional medical routine consultation, measured on both clinical and psychological factors [17][18][19]. Likewise, security was maintained with same level of decreased disease activity in PIFU guided by tight control of disease activity without affecting patient satisfaction, even among newly diagnosed patients, compared to traditional outpatient consultation every 3-4 months [21].…”