Session Type: Abstract Submissions (ACR)
Managing complex arthritic patients with biologics is exacting and time consuming. As a result in January 2008 we established a separate biologic clinic with a clinic manager and team of experienced Registered Nurses linked to the general rheumatology clinic and early inflammatory arthritis clinic to assess, initiate, and follow patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), and Psoriatic Arthritis (PsA) needing to transition to biologic treatment and requiring care and follow-up while on biologics. This team approach using experienced rheumatology nurses allows for triaging and timely access to care.
Approximately 770 patients, 60% RA, 20% PsA and 20% AS are being followed in the biologic program. All patients are initially assessed by an RN, examined to a standard protocol and then the treatment, assessment and plan of care is reviewed by the attending rheumatologist. The clinic is structured using a primary care nursing model which promotes continuity and a patient centered therapeutic approach to care. Nurses are responsible for assessing their patients providing disease and treatment related heath teaching and providing injection training. The nurses also perform the clinical outcome measurements including spondylarthropathy measures, joint evaluations and administration and scoring of patient reported outcome questionnaires. The team manages and reviews routine labs and diagnostics daily, provides follow-up calls to patients to discuss adverse events, flares, concerns and treatment related inquiries. Patients are seen a minimum of 3 times per year with most followed 6 times per year because of flares, co-morbidities, treatment adjustment or financial issues. The clinic operates as a primary point of contact for organizing management of co-morbidities, infusions and injections and ensures patients are being treated to target. The nurses are occasional speakers at national and regional rheumatology meetings to share best practices on the management of biological patients and how a team-based approach can improve efficiency and promote better patient outcomes.
This rheumatology health team managing patients on biologic treatment has exponentially grown and has worked well over a four-year period. The team approach allows one rheumatologist to follow 5-7 times the number of patients seen by the average rheumatologist who does not have the team support. Currently in Canada we have approximately 1/3 of the rheumatologists we need for optimal care and a team based approach can help fill this gap, reducing the burden on the health care system with fewer visits to urgent care or Emergency departments. The team assesses 3-5 new patients a week for biologics and starts 2-3 patients per week on biologics.
The goal in the biologic clinic is treating to target for remission or lowest disease activity possible within the shortest period of time. This team approach to care has resulted in improved adherence to therapy, less risks and reported adverse events, improved safety monitoring and better patient satisfaction.
W. G. Bensen,
Abbott, Amgen, Astra Zeneca, BMS, Merck-Schering, Janssen, Lilly, Novartis, Pfizer and Wyeth, Proctor and Gamble, Roche, Sanofi Aventis, Servier, UCB, Warner Chilcott ,
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/team-managed-care-of-biological-patients-at-a-canadian-centre/