Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases

Abstract

Objective. Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics.Design. Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care. Semi-structured interviews with professionals were used to gather information about their perceptions.Setting. The study was carried out at five locations in The Netherlands where a home care organization and a general hospital collaborated closely and had joint responsibility for a transmural rheumatology nurse clinic.Study participants. A total of 128 patients, six specialist rheumatology nurses and four rheumatologists. Intervention. Transmural nurse clinics for people with rheumatic diseases.Results. In general, patients were positive about the quality and continuity of care given at the clinics. Some continuity aspects, like the presence of a locum nurse and providing the locum with sufficient information could be improved. Professionals were positive about the information given at the clinics, which is additional to the information given by a rheumatologist. Professionals were less positive about some of the clinics' preconditions. Conclusion.In this study, a control group (e.g. patients who received standard rheumatologist care) was not available. However, in comparison with patients' experiences of standard medical care in other (comparable) research, patients' experiences in this study were very positive. It was concluded that Dutch transmural nurse clinics, to a large extent, meet patients' and professionals' expectations and were a positive development in the care of rheumatic patients.Keywords: continuity of care, nurse clinics, patient education, quality of care, rheumatic diseases, transmural care.It appears to be difficult for health care organizations to critical about waiting time when attending rheumatology outpatient clinics and about the co-ordination of care given provide people with a chronic illness with good quality care; for example, the literature shows that few of those by rheumatologists [3,4].People suffering from a chronic disease are often conwith rheumatoid arthritis are satisfied with the options available for the adaptation of the living environment as fronted with disabilities in their daily life and require help from several health care professionals in different settings provided by standard medical services. In addition, people with rheumatoid arthritis often feel that they do not receive [5]. Importance is therefore attached to communication, quality and continuity of care [6][7][8][9]. Consequently new forms enough information from standard medical care services [1], there is inadequate doctor-pa...

EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

“…Patients valued nurses' communication skills and nursing care in terms of advice to use assistive devices, referral to other members of the multidisciplinary team and education 26 27. Quality and continuity of care in nurse-led clinics were perceived as good 28. Holistic care and patient-centred information were found to contribute to patient satisfaction 29…”

“…Qualitative studies provide important insight in patients' individual needs, functional limitations and the extent to which different types of care meet those needs,78 all of which may improve quality of care 21 28 79. However, these studies are rated with a lower level of evidence than RCTs, and subsequently, there is a high risk of bias.…”

Measuring patient assessments of the quality of outpatient care: a systematic review

“…More than half of the studies ( n = 19, 53%) reported evaluation of organization of delivery of care, and patient satisfaction was a component of this evaluation [5,25,29,30,34,35,37–46,49–51]. Eight studies were at least partly concerned to develop a measurement method or a tool [6,7,22,31,32,35,37,51].…”

Patients' Perceptions of Interpersonal Continuity of Care

“…8 Interpersonal continuity has been studied in patients with specific chronic conditions and found to be important to parents of children with cleft lip and palate, 26 asthma, 28 and to patients with rheumatic diseases. 30 Other studies have found that the majority of patients state a preference for their regular doctor for potentially chronic conditions such as back pain, 11,31 seasonal allergies, and depression. 11 Patients with chronic illness were found to value regular visits with their physician to check the progression of their disease.…”

“…32 Besides interpersonal continuity, chronic disease patients seem to value the transfer of their medical information between providers, which has been termed informational continuity. 9 Chronic disease patients appreciate informational continuity in the situations involving transfer of care between nurse and physician, 30 hospitalization, 32 and outpatient care teams. 7 They report that this transfer of information saves them time by not having to repeat information.…”