Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol

Paudyal, Priyamvada, Perry, Mark, Child, Sue and Gericke, Christian A. (2012) Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol. BMC Musculoskeletal Disorders, 13 157-157. doi:10.1186/1471-2474-13-120

Author Paudyal, Priyamvada
Perry, Mark
Child, Sue
Gericke, Christian A.
Title Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol
Journal name BMC Musculoskeletal Disorders   Check publisher's open access policy
ISSN 1471-2474
Publication date 2012-07-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/1471-2474-13-120
Open Access Status DOI
Volume 13
Start page 157
End page 157
Total pages 5
Place of publication London United Kingdom
Publisher BioMed Central
Language eng
Abstract The management of Rheumatoid Arthritis (RA), a chronic relapsing condition primarily affecting joints usually entails regular hospital reviews with a specialist. These reviews can occur when the patient is well. This study forms part of a service evaluation of a system wide implementation of a patient initiated review appointment system which we have called Direct Access (DA). The aim was to explore the experiences of patients and staff of a DA system in order to understand the process of the implementation and to identify potential improvements.
Formatted abstract
Rheumatoid arthritis is a chronic inflammatory condition that affects the joints causing unpredictable episodes of pain, stiffness and disability. People with rheumatoid arthritis usually require lifelong specialist follow-up but frequently have periods when their disease can be managed through self-care or that provided by their general practitioner. Compared to the traditional clinician-driven care in rheumatoid arthritis, patient-initiated care has proven to be more beneficial in terms of reducing unnecessary medical reviews, providing greater satisfaction to patients and staffs and maintaining the patient’s physical and psychological status. We aim to evaluate the implementation of a patient-initiated review system in a routine secondary care rheumatology service in a public hospital in England, where patients get the opportunity to self-manage their disease by requesting specialist reviews at times of need instead of clinician-scheduled appointments.

Three hundred and eighty patients attending routine review at Plymouth Hospitals NHS Trust will be randomised to either enrol immediately into a patient-initiated review system (direct access group), or to be seen regularly by a clinician at the hospital (regular clinician-initiated group). Patients (or their general practitioner) in the direct access group can arrange a review by calling a rheumatology nurse-led advice line that enables telephone delivered clinical advice, or where appropriate, an appointment with a rheumatologist within 10 working days. Patients in the regular clinician-initiated group will attend their planned appointments at regular intervals during the intervening period of 12 months. The primary outcome of interest is patient satisfaction; secondary outcomes include service use, waiting times and clinical measures. Semi-structured, in-depth interviews will be conducted with a subset of patients and staff with the aim of identifying facilitators/barriers in implementing patient-initiated clinics.

The implementation of a patient-initiated review system in routine care rheumatology will replace the fixed clinician-driven review system with a more flexible patient-driven system where patients usually self-manage their disease, but can request prompt help when required. We believe that this study will enable a comparison of the changes in local services and will be helpful in exploring the benefits/drawbacks of such implementation, thus providing lessons for implementation in other hospitals and for other chronic diseases.
Keyword Randomized controlled-trial
Hospital follow-up
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID RDA/02/06/41
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Public Health Publications
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