Patient satisfaction with nursing consultations in a rheumatology outpatient clinic: a 21-month randomised controlled trial in patients with inflammatory arthritides

Abstract

Objective To study the effect of individual nursing consultations in patients treated with disease-modifying antirheumatic drugs (DMARDs) in a rheumatology outpatient setting. Methods Patients with inflammatory arthritides (IA) who had started with a DMARD regimen 3 months before were randomised to two different follow-up consultation systems: either follow-up by a clinical nurse specialist (CNS) or by a medical doctor (MD) in rheumatology 3, 9 and 21 months after randomisation. The primary outcome was patient satisfaction measured by Leeds Satisfaction Questionnaire (LSQ). Secondary outcomes included coping, disease activity, pain, fatigue, patient's global assessment of disease activity and health related quality of life. Effects at 9 and 21 months were estimated by Least Square means calculated from the final mixed model. Results Of 68 patients randomised, 65 patients completed assessments at 21 months. Statistically significant improvements in favour of the CNS group were found in all LSQ subscales (all p values <0.001) and in overall satisfaction at 9 months (adjusted mean between-group difference 0.74, 95% CI −0.96 to −0.52) and at 21 months (−0.69, 96% CI −0.87 to −0.50). Disease activity Score 28 joint count (DAS-28) was improved from baseline to 9 months in both groups and improvement was maintained at 21 months, but without any group difference. No statistically significant between-group differences were found in any of the other secondary outcomes. Conclusions Patients with IA are likely to benefit from nurse consultations in terms of increased satisfaction with care compared with MD consultations and without loss of efficacy in terms of clinical outcomes. The study is registered as a clinical trial at the ClinicalTrials.gov (NCT00403676).

A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial

“…Refusal to participate in trials that increase patient involvement in healthcare has been linked to a reluctance to disrupt services and relationships that are working well and are highly valued 48. This may further account for the high rates of refusal found in the current trial, particularly as nurse-led services are associated with greater levels of satisfaction with care than consultant-led clinics 49. In countries in which the role of the CNS in rheumatology is still in its infancy,50–52 there is still much work to be done to establish these services.…”

Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice

“…This is a key challenge, particularly in the rheumatology setting. A systematic approach using healthcare professionals other than doctors; for example nurse specialists, is likely to be the most successful way to implement new systems in clinical practice 13 14. Indeed, Ikdahl and coworkers argue that a systematic, team-based model for data collection may be necessary to optimise recording of CVD risk factors in patients with RA attending a rheumatology outpatient clinic 7.…”

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

“…Apesar de, tradicionalmente, as pessoas com AR serem monitorizadas periodicamente em consultas médicas (Primdahl et al, 2014;Sorensen et al, 2015), vários estudos e a síntese narrativa evidenciam resultados favoráveis quando este seguimento é realizado também por enfermeiros, nomeadamente na capacidade funcional, na qualidade de vida, na dor (Ndosi et al, 2014), e na satisfação global (Koksvik et al, 2013;Ndosi et al, 2014;Primdahl et al, 2014). Para além destes resultados é ainda evidente a não-inferioridade (não existindo diferenças estatisticamente significativas) das CE em relação às CR, por exemplo, nos outcomes: atividade da doença, capacidade funcional (Larsson et al, 2014;Primdahl et al, 2014;Sorensen et al, 2015), fadiga (Koksvik et al, 2013;Primdahl et al, 2014), qualidade de vida (Koksvik et al, 2013;Primdahl et al, 2014;Sorensen et al, 2015) e dor (Koksvik et al, 2013;Larsson et al, 2014;Primdahl et al, 2014).…”

“…Para além destes resultados é ainda evidente a não-inferioridade (não existindo diferenças estatisticamente significativas) das CE em relação às CR, por exemplo, nos outcomes: atividade da doença, capacidade funcional (Larsson et al, 2014;Primdahl et al, 2014;Sorensen et al, 2015), fadiga (Koksvik et al, 2013;Primdahl et al, 2014), qualidade de vida (Koksvik et al, 2013;Primdahl et al, 2014;Sorensen et al, 2015) e dor (Koksvik et al, 2013;Larsson et al, 2014;Primdahl et al, 2014). Os resultados da síntese narrativa sugerem, ainda, que quando comparamos as CE com as CR ou com as consultas partilhadas sem agendamento (CE/CR) não são encontradas diferenças significativas no controlo da atividade da doença (DAS28), existindo até benefício, embora não atinja o nível de significância estatística; e que as pessoas ficam mais satisfeitas com as CE.…”

“…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.…”