Background/Purpose: Early, more aggressive treatment of rheumatoid arthritis (RA) has resulted in greatly improved outcomes compared to past decades. However, because of heterogeneity and complexity of RA disease course and potential toxicity of therapies, shared decision-making (SDM) between physician and patient is central to patient safety and outcomes. Patient education (PE) is a useful tool for patient empowerment, since patients should aware of their disease course, treatment target, medications and their adverse effects. However, it is uncertain that how we can measure the clinical benefits of PE and who should be responsible for educating patients. This study aims to examine the impact of PE on the patients’ satisfaction in RA patients and to compare the nurse-led education with physician-led education for RA patients.

Methods: Patients were enrolled by categorizing in three according to their clinical characteristics: early RA patient (<2 years of disease duration) with conventional DMARDs (Group I), established RA patients (≥ 2 years of disease duration) with conventional DMARDs (Group II), and RA patients treated with biologic DMARDs (Group III). After constructing two groups of nurse-led and physician-led education, stratified randomization was performed by randomly assigning the two education groups separately within each group by characteristics. Patient education materials were composed of the characteristics and outcomes of RA, T2T, treatment options with side effects, and comorbidities. Two times of face-to-face education was performed and changes in patient satisfaction before and after PE were assessed using visual analogue scale (VAS, 0-100mm) and Leeds Satisfaction Questionnaire (LSQ) score. Changes of patients’ outcomes were measured using DAS28-ESR, HAQ-DI, and EQ-5D scores. Changes of patients’ satisfaction and disease outcomes between before and after PE were compared using paired t-test, and the comparison between nurse-led and physician-led education was analyzed using independent t-test.

Results: A total of 120 RA patients, 40 patients from each groups, were randomized to receive either nurse-led or physician-led education. Among them, 113 patients completely received twice face-to-face education and final assessment with 1 or 2 month interval: 38, 36, and 39 patients in group I, II, and III, respectively. In total patients, patients’ satisfaction by PE was significantly increased from 87.8 (± 13.1) to 92.3(± 8.8) in VAS (p<0.01), and from 3.7 (± 0.4) to 4.0 (± 0.4) in LSQ score (p<0.01). The improvement of patients’ satisfaction measured with LSQ was highest in group I (0.45 ± 0.45) and followed by group II (0.22 ± 0.34) and group III (0.19 ± 0.38). However, there was no improvement in DAS28-ESR, HAQ, or quality of life after PE. Improvement of patients’ satisfaction by LSQ after nurse-led education was 0.37 ± 0.37 and it was higher than 0.27±0.45 after physician-led education, but it was not statistically different (P =0.25).

Conclusion: Patient education in outpatient clinic for RA patients improved patients’ satisfaction, especially in patients with early stage. Nurse-led education showed comparable improvement in patients’ satisfaction with physician-led education.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-patient-education-on-the-satisfaction-of-rheumatoid-arthritis-patient-a-randomized-trial-of-nurse-led-vs-physician-led-education/