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Rheumatoid arthritis is a chronic disease for which traditionally patients have attended follow up (FU) clinics at regular intervals irrespective of patient’s need. Patient initiated consultation (PIC) is a novel idea that attempts to address this. In previous studies of a selected group of patients no significant differences were noted either in patient satisfaction or outcome.1 In one hospital PIC is the norm in contrast to traditional follow up at another hospital. We have audited the outcome in these two groups of unselected patients at these hospitals.
Methods
Audit data were collected from 173 outpatient FU appointments. Underlying diagnosis, type of appointment and nature of any intervention was noted. Meaningful intervention was defined as alteration of DMRD therapy, joint injection, admission or investigation for specific problem. Opportunistic referral to another health care practitioner or simple blood test was not considered to be a meaningful intervention.
Results
107 pts (61.8%) had an inflammatory arthritis and 22 (12.7%) had degenerative disease. 44 (25.5%) had other rheumatological conditions. 113 (65.3%) of these appointments were routine vs 60 (34.7%) PIC. PIC yielded a significantly higher rate of all interventions - 96.7% compared to 52.2% from routine appointments (p<0.00001). PIC’s were also associated with higher rates of meaningful intervention at 66.7% vs 30.1% in routine appointments (p<0.00001). Time between appointments did not differ significantly between the two groups (mean 6.7 vs 7.3 months, routine vs PIC, p=0.448).
Discussion
Previous work in our unit has shown that patients are equally satisfied with either a patient initiated approach or a conventional approach to follow-up.2 Patient initiated approach to outpatient appointments yields a higher rate of clinical intervention, reducing unnecessary follow-ups. PIC approach allows easy access of patients with flares of their disease. As clinicians have more time, waiting lists for new patients are reduced and clinical outcome is not compromised.1 We have calculated that our PIC approach will release enough time for an increase of approximately 25% more new patient throughput. There was no evidence to suggest that patients inappropriately accessed the service through PIC.
We recommend that outpatient services for patients with stable chronic disease should be moved more towards a PIC approach thus empowering patients to decide when to seek medical attention and also encourage them in self-management of their condition.
1 Hewlett S, Kirwan J, Pollock J, Mitchell K, Hehir M, Blair PS, Memel D, Perry MG. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. Bmj. 2005;330:171.
2. Sands A. MSc Research Project. Wrightington, Wigan and Leigh NHS Trust Lancashire Teaching Hospitals NHS Trust.
Methods
Audit data were collected from 173 outpatient FU appointments. Underlying diagnosis, type of appointment and nature of any intervention was noted. Meaningful intervention was defined as alteration of DMRD therapy, joint injection, admission or investigation for specific problem. Opportunistic referral to another health care practitioner or simple blood test was not considered to be a meaningful intervention.
Results
107 pts (61.8%) had an inflammatory arthritis and 22 (12.7%) had degenerative disease. 44 (25.5%) had other rheumatological conditions. 113 (65.3%) of these appointments were routine vs 60 (34.7%) PIC. PIC yielded a significantly higher rate of all interventions - 96.7% compared to 52.2% from routine appointments (p<0.00001). PIC’s were also associated with higher rates of meaningful intervention at 66.7% vs 30.1% in routine appointments (p<0.00001). Time between appointments did not differ significantly between the two groups (mean 6.7 vs 7.3 months, routine vs PIC, p=0.448).
Discussion
Previous work in our unit has shown that patients are equally satisfied with either a patient initiated approach or a conventional approach to follow-up.2 Patient initiated approach to outpatient appointments yields a higher rate of clinical intervention, reducing unnecessary follow-ups. PIC approach allows easy access of patients with flares of their disease. As clinicians have more time, waiting lists for new patients are reduced and clinical outcome is not compromised.1 We have calculated that our PIC approach will release enough time for an increase of approximately 25% more new patient throughput. There was no evidence to suggest that patients inappropriately accessed the service through PIC.
We recommend that outpatient services for patients with stable chronic disease should be moved more towards a PIC approach thus empowering patients to decide when to seek medical attention and also encourage them in self-management of their condition.
1 Hewlett S, Kirwan J, Pollock J, Mitchell K, Hehir M, Blair PS, Memel D, Perry MG. Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial. Bmj. 2005;330:171.
2. Sands A. MSc Research Project. Wrightington, Wigan and Leigh NHS Trust Lancashire Teaching Hospitals NHS Trust.
C. Chattopadhyay, None; P.M. Hickey, None.