A comparison of patient-initiated versus conventional follow-up for rheumatoid arthritis

Patients with rheumatoid arthritis are traditionally seen at regular intervals initiated by the rheumatologist. This has resulted in a high volume of costly out-patient reviews creating difficulty for out-patient services to respond to patients in times of need. Research has shown that patients prefer to initiate their own follow-up which has reduced unnecessary out-patient appointments while maintaining patients’ physical and psychological status. Aims and objectives: The aims of the study were to evaluate whether there were any differences in standardised outcome measures for rheumatoid arthritis patients participating in a patient-initiated system of follow-up compared to a conventional, rheumatologist-initiated system and secondly to explore the perspectives of these patients. Functional, psychological and satisfaction outcomes were assessed and patients’ experiences and views investigated. Methods: Comparative pragmatic study in which mixed methods were used to collect data in two phases. Eighty-eight participants completed the following questionnaires: Arthritis Impact Measurement Scales-2 Short Form, Hospital Anxiety and Depression Scale and a visual analogue scale to measure satisfaction and confidence, and twelve patients then participated in semi-structured interviews. Results: No statistically significant differences between groups for functional, psychological and satisfaction status were found, however those who initiated their own follow-up used fewer resources, felt their appointments were less rushed and were more satisfied with the continuity of their care. Conclusion: Rheumatology services need to face the challenge of overcrowded out-patient departments by empowering patients to initiate their own follow-up care.