Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: A randomized controlled trial

Abstract

Objective. To evaluate the substitution of specialized rheumatology nurses for rheumatologists in diagnosing fibromyalgia (FM).Methods. Referred patients with FM symptoms (n ‫؍‬ 193) were randomized to a study group diagnosed by a specialized rheumatology nurse (SRN group, n ‫؍‬ 97) or to a control group diagnosed by a rheumatologist (RMT group, n ‫؍‬ 96). SRN patients were seen within 3 weeks by a nurse who took structured history and initiated routine laboratory tests. During a 5-minute supervision session, the rheumatologist was informed by the nurse about medical history, performed a brief physical examination, and confirmed or rejected the nurse's diagnosis. RMT patients were seen by a rheumatologist after a regular waiting period of 3 months. Outcome measures were initial agreement between the nurse and rheumatologist in the SRN group, final diagnosis after 12-24 months of followup, patient satisfaction, and diagnostic costs. Results. The mean waiting time after randomization was 2.8 and 12.1 weeks in the SRN and RMT groups, respectively. Eight RMT patients cancelled their appointments because of the waiting time. Excellent agreement ( ‫؍‬ 0.91) between rheumatologists and nurses was found. After 12-24 months of followup, none of the initial diagnoses were recalled in either group. SRN patients were significantly more satisfied than RMT patients. Mean diagnostic costs were lower in the SRN group (€219) than in the RMT group (€281) (95% uncertainty interval €؊103, €؊20). Conclusion. Substituting specialized nurses for rheumatologists in the diagnostic process of FM is a trustworthy and successful approach that saves waiting time, provides greater patient satisfaction, and is cost-effective.

Organizational determinants of patient-centered fertility care: a multilevel analysis

“…The panel's decision process was supported by evidence from general and fertility literature. Five organizational determinants were selected: [1] clinic size, by number of beds (7,22,23); [2] presence of special fertility consultation hours (12); [3] presence of trained fertility nurses (24)(25)(26); [4] availability of a lead physician during treatment (27); and [5] free access of patients to their own electronic personal health record (PHR) (28,29).…”

Specialized Rheumatology Nurse Substitutes for Rheumatologists in the Diagnostic Process of Fibromyalgia: A Cost-Consequence Analysis and a Randomized Controlled Trial

“…The procedure of this RCT has been described in detail 24 . Patients were randomly assigned to either the nurse-led diagnostic consultation (SRN group) or to the regular physician-led diagnostic consultation [usual care (UC) group].…”

“…Prices were generally obtained from Dutch standard prices that were defined to reflect societal costs and to standardize economic evaluations 42 . The calculation of costs of the diagnostic process has been described in detail 24 . We used the tariffs of the Dutch National Health Tariffs Authority of 2006.…”

“…The power calculation was based upon the acceptability of a 3-month waiting time for a first visit led by a rheumatologist, as described 24 .…”

“…In our previous study on the feasibility of substituting SRN for rheumatologists (RMT) in the diagnostic process of FM, we have shown that this approach is safe (no misclassifications), avoids waiting time, provides better patient satisfaction, and is cheaper from a health service perspective 24 . Insight into the full societal consequence of this nurse-led diagnostic process is important for health professionals, healthcare management, health policy decision makers, and third-party payers.…”