Patient Satisfaction and Costs of Multidisciplinary Models of Care in Rheumatology: a Review of the Recent Literature
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Purpose of the Review
A number of novel models of care utilizing allied healthcare professionals, including nurses and pharmacists, have emerged as an alternate to rheumatologist specialist care to achieve disease outcomes in patients with inflammatory arthritis. We conducted a review of the literature for studies from the past 5 years that reported on measures of patient satisfaction and/or any health economic outcome in a model of care where the care providers had substantial, but not completely independent, responsibility.
Previous reviews have summarized the available evidence for collaborative models of care led by nurses (only), which demonstrate that patients with inflammatory arthritis achieve similar disease outcomes and feel well supported with their person-centered care.
Patients are generally highly satisfied with the care provided in collaborative care models, in line with if not greater than that provided by rheumatologists. However, we identified substantial variability in direct costs and/or overall intervention costs and measures of health-related quality of life across the various countries and healthcare systems. Overall, nursing-led interventions likely cost more than do physician-led models of care in the short-term but may lead to greater quality of life, as demonstrated with a disease-specific measure.
KeywordsInflammatory arthritis Multidisciplinary care Model of care Patient satisfaction Costs Health economics
This work was supported by Canadian Institutes of Health Research (CIHR) Project grant no. 148842, (MH), The Arthritis Society—Strategic Operating grant 2016 (SOG-16-369) (MH) and Young Investigator Salary Award 2016 (YIS-16-104) (MH), and Michael Smith Foundation for Health Research Scholar Award 2017 (no. 16813) (MH).
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Harrison reports grants from Canadian Institutes of Health Research, grants from The Arthritis Society, and from Michael Smith Foundation for Health Research, during the conduct of the study.
Jill Hall, K. Julia Kaal, Junho Lee, Ross Duncan, and Nicole Tsao declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol Hoboken NJ [internet]. 2016;68:1–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26545940.CrossRefGoogle Scholar
- 2.Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis [Internet]. 2017;76:960–77. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2016-210715 CrossRefGoogle Scholar
- 3.Chamberlain-Salaun J, Mills, Usher K. Terminology used to describe health care teams: an integrative review of the literature. J Multidiscip Healthc. [Internet]. 2013 [cited 2017 Dec 11];65. Available from: http://www.dovepress.com/terminology-used-to-describe-health-care-teams-an-integrative-review-o-peer-reviewed-article-JMDH
- 5.Widdifield J, Paterson J, Bernatsky S. Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system. Bmj [Internet]. 2014; 4. Available from: http://bmjopen.bmj.com/content/4/1/e003888.abstract
- 6.van Eijk-Hustings Y, van Tubergen A, Boström C, Braychenko E, Buss B, Felix J. EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis: table 1. Ann Rheum Dis [Internet]. 2012;71:13–9. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2011-200185 CrossRefGoogle Scholar
- 9.Watts RA, Mooney J, Barton G, MacGregor AJ, Shepstone L, Irvine L, et al. The outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis: a non-randomised pragmatic study. BMJ Open [Internet]. 2015;5:e007696. Available from: http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2015-007696 CrossRefGoogle Scholar
- 11.• Ndosi M, Lewis M, Hale C, Quinn H, Ryan S, Emery P, et al. The outcome and cost effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Ann Rheum Dis [internet]. 2014;73:1975–82. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2013-203433. This randomized controlled trial provides clinical outcome data along with measures of patient satisfaction and health economic outcomes. CrossRefGoogle Scholar
- 15.Primdahl J, Sørensen J, Horn HC, Petersen R, Hørslev-Petersen K. Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity—patient outcomes from a 2-year, randomised controlled trial. Ann Rheum Dis[Internet]. 2014;73:357–64. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2012-202695 CrossRefGoogle Scholar
- 17.Arthur V, Clifford C. Rheumatology: the expectations and preferences of patients for their follow-up monitoring care: a qualitative study to determine the dimensions of patient satisfaction. J Clin Nurs [internet]. 2004;13:234–42. https://doi.org/10.1046/j.1365-2702.2003.00873.x%5Cnhttp://ezproxy.lib.ucf.edu/login?URL=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=11956496&site=ehost-live.CrossRefGoogle Scholar
- 22.• Larsson I, Fridlund B, Arvidsson B, Teleman A, Svedberg P, Bergman S. A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial. BMC Musculoskelet Disord [Internet]. 2015;16:354. Available from: http://www.biomedcentral.com/1471-2474/16/354 .This randomized controlled trial provides clinical outcome data (see reference 37) along with measures of patient satisfaction and health economic outcomes. CrossRefGoogle Scholar
- 23.• Sørensen J, Primdahl J, Horn H, Hørslev-Petersen K. Shared care or nurse consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis (RA) outpatients with stable low disease-activity RA: cost-effectiveness based on a 2-year randomized trial. Scand J Rheumatol [Internet]. 2015;44:13–21. Available from: http://www.tandfonline.com/doi/full/10.3109/03009742.2014.928945. This randomized controlled trial provides clinical outcome data (see reference 15) along with measures of patient satisfaction and health economic outcomes. CrossRefGoogle Scholar
- 24.OECD. Purchasing power parities (PPP) [Internet]. OECD Publishing; 2014 [cited 2017 Dec 14]. Available from: http://www.oecd-ilibrary.org/finance-and-investment/purchasing-power-parities-ppp/indicator/english_1290ee5a-en
- 25.OECD. Inflation (CPI) [Internet]. OECD Publishing; 2014 [cited 2017 Dec 14]. Available from: http://www.oecd-ilibrary.org/economics/inflation-cpi/indicator/english_eee82e6e-en
- 27.Koksvik HS, Hagen KB, Rødevand E, Mowinckel P, Kvien TK, Zangi HA. Patient satisfaction with nursing consultations in a rheumatology outpatient clinic: a 21-month randomised controlled trial in patients with inflammatory arthritides. Ann Rheum Dis [Internet]. 2013;72:836–43. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2012-202296 CrossRefGoogle Scholar
- 28.Ndosi M, Vinall K, Hale C, Bird H, Hill J. The effectiveness of nurse-led care in people with rheumatoid arthritis: a systematic review. Int J Nurs Stud [Internet]. 2011 [cited 2017 Dec 18];48:642–54. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0020748911000460
- 31.Hill J, Bird HA, Hopkins R, Lawton C, Wright V. Survey of satisfaction with care in a rheumatology outpatient clinic. Ann Rheum Dis [Internet]. 1992;51:195–7. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005657/ CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Donald FC. Review: nurse practitioner primary care improves patient satisfaction and quality of care with no difference in health outcomes. Evid Based Nurs [Internet]. 2002 [cited 2017 Dec 14];5:121–121. Available from: http://ebn.bmj.com/cgi/doi/10.1136/ebn.5.4.121
- 35.Dures E, Fraser I, Almeida C, Peterson A, Caesley J, Pollock J, et al. Patients’ perspectives on the psychological impact of inflammatory arthritis and meeting the associated support needs: open-ended responses in a multi-centre survey: meeting psychological support needs. Musculoskeletal Care [Internet]. 2017 [cited 2017 Dec 14];15:175–85. https://doi.org/10.1002/msc.1159
- 36.van Tuyl LHD, Hewlett S, Sadlonova M, Davis B, Flurey C, Hoogland W, et al. The patient perspective on remission in rheumatoid arthritis: “You”ve got limits, but you’re back to being you again’. Ann Rheum Dis [Internet]. 2015 [cited 2017 Dec 14];74:1004–10. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2013-204798
- 37.Bartlett SJ, Hewlett S, Bingham CO, Woodworth TG, Alten R, Pohl C, et al. Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus. Ann Rheum Dis [Internet]. 2012 [cited 2017 Dec 14];71:1855–60. Available from: http://ard.bmj.com/lookup/doi/10.1136/annrheumdis-2011-201201
- 38.Abdelhamid AS, Mooney J, Walker AA, Barton G, MacGregor AJ, Scott DG, et al. An evaluation of rheumatology practitioner outreach clinics: a qualitative study. BMC Health Serv Res [Internet]. 2012;12:119. Available from: http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-12-119 CrossRefGoogle Scholar