Background/Purpose:

Rheumatology is mainly an outpatient specialty. Prompt diagnosis & treatment to prevent long-term disability in an integrated, multi-disciplinary approach to care are crucial.  In reality though, not many clinics provide this level of service.

Methods:

Descriptive report & patient satisfaction survey of a rheumatology clinic model  which was first developed in 1996 to enhance the patient ‘journey’ through rheumatology services.  A patient-satisfaction survey assessed several aspects of care including quality of services, consultations, treatment & patient education.  All patients visiting the rheumatology department over a 3-week period were invited to participate.

Results:

All primary care referrals are screened by a rheumatologist to pre-schedule laboratory/radiology tests for the visit.  Upon arrival to the clinic, patients check-in at an electronic desk, then are guided by a receptionist to complete the electronic Go-TreatIT monitoring system (assesses patient-reported outcomes e.g. pain, fatigue) at private stations within the clinic. Of all the collected data the program then generates commonly used comparable values e.g. HAQ, DAS28 & BASFI.  The patient is reviewed by a doctor in a 30-60 minute consultation depending on whether it is a 1st or follow-up visit, then by a nurse (for diagnosis/treatment education, vaccinations, assessment of psychological status etc). An ultrasound machine & capillaroscopy are available for use in clinic.  Patients can be scheduled  on the same day to see a nutritionist, physiotherapist, podiatrist or other professionals as needed.  An ‘early-RA treatment path’ is available to ensure early, intensive treatment (with combination triple DMARD therapy, intra articular & oral steroids). Steps in the process will be diagrammatically shown.

Survey: From 141 recipients, 86% completed a questionnaire;67% female;12% were on their first visit. Mean age:54.3 yrs; 37% retired. 51% had a diagnosis of RA; the remaining included ankylosing spondylitis, psoriatic arthritis, fibromyalgia, lupus, vasculitis. Most valued was the information & education provided by doctors/nurses & addressing patients’ current issues.  93 % of patient ‘agreed’ that their medical care was high quality, 77 % ‘strongly agreed’. The mean score overall assessment of the service was 90.6/100. Only 6% gave negative feedback. The main complaint was difficulty with using the electronic check-in tool (not GoTreatIT). Some patients expressed disappointment for not finding the cause for their symptoms. None of the patients felt they lacked education on their disease or medication. 92% strongly agreed they were given sufficient education.  6% of patients felt that they were overwhelmed with information, 82% were content with the amount of information given. The multi-disciplinary approach was valued & only 3% would rather see doctor and nurse on separate days.

Conclusion:

The specific clinic model provides an ideal setting for a one-stop service, avoiding unnecessary visits, collecting important patient data & enhancing the patient experience & journey through the system.

« Back to ACR/ARHP Annual Meeting 2015

ACR Meeting Abstracts - https://acrabstracts.org/abstract/delivering-a-one-stop-integrated-patient-centred-service-for-patients-with-rheumatic-diseases-the-finnish-approach/