Implementing a patient-initiated review system for people with rheumatoid arthritis: a prospective, comparative service evaluation

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Rationale, aims and objectives</jats:title><jats:p>The management of rheumatoid arthritis (<jats:styled-content style="fixed-case">RA</jats:styled-content>) usually entails regular hospital reviews with a specialist often when the patient is well rather than during a period of exacerbation. An alternative approach where patients initiate appointments when they need them can improve patient satisfaction and resource use whilst being safe. This service evaluation reports a system‐wide implementation of a patient‐initiated review appointment system called Direct Access (<jats:styled-content style="fixed-case">DA</jats:styled-content>) for people with <jats:styled-content style="fixed-case">RA</jats:styled-content>. The aim was to establish the impact on patient satisfaction of the new system versus usual care as well as evaluate the implementation processes.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>As all patients could not start on the new system at once, in order to manage the implementation, patients were randomly allocated to <jats:styled-content style="fixed-case">DA</jats:styled-content> or to usual care. Instead of regular follow‐up appointments, <jats:styled-content style="fixed-case">DA</jats:styled-content> comprised an education session and access to a nurse‐led telephone advice line where appointments could be accessed within two weeks. Usual care comprised routine follow‐ups with the specialist. Data were collected on patient satisfaction, service use and outcomes of any contact to the advice line.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Three hundred and eleven patients with <jats:styled-content style="fixed-case">RA</jats:styled-content> were assessed as being suitable for <jats:styled-content style="fixed-case">DA</jats:styled-content>. In terms of patient satisfaction, between‐group differences were found in favour of <jats:styled-content style="fixed-case">DA</jats:styled-content> for accessibility and convenience, ease of contacting the nurse and overall satisfaction with the service. Self‐reported visits to the general practitioner were also significantly lower. <jats:styled-content style="fixed-case">DA</jats:styled-content> resulted in a greater number of telephone contacts (incidence rate ratio = 1.69; 95% confidence interval 1.07 to 2.68). Hospital costs of the two different service models were similar. Mean waiting time for an appointment was 10.8 days</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This service evaluation found that <jats:styled-content style="fixed-case">DA</jats:styled-content> could be implemented and it demonstrated patient benefit in a real‐world setting. Further research establishing the broader cost–consequences across the whole patient pathway would add to our findings.</jats:p></jats:sec>