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Patient Satisfaction and Costs of Multidisciplinary Models of Care in Rheumatology: a Review of the Recent Literature

  • Health Economics & Quality of Life (N Tsao, Section Editor)
  • Published:
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Abstract

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.

Recent Findings

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.

Summary

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.

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References

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.

    Article  Google 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

    Article  Google 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

  4. Vliet Vlieland TPM. New models of care for patients with rheumatoid arthritis. Expert Rev Pharmacoecon Outcomes Res. 2006;6:159–69.

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  7. 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;48:642–54. https://doi.org/10.1016/j.ijnurstu.2011.02.007.

    Article  Google Scholar 

  8. Vinall-Collier K, Madill A, Firth J. A multi-centre study of interactional style in nurse specialist- and physician-led rheumatology clinics in the UK. Int J Nurs Stud [Internet]. 2016;59:41–50. https://doi.org/10.1016/j.ijnurstu.2016.02.009.

    Article  Google 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

    Article  Google Scholar 

  10. Hill J, Bird HA, Harmer R, Wright V, Lawton C. An evaluation of the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Br J Rheumatol. 1994;33:283–8.

    Article  CAS  PubMed  Google 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.

    Article  Google Scholar 

  12. Hill J, Thorpe R, Bird H. Outcomes for patients with RA: a rheumatology nurse practitioner clinic compared to standard outpatient care. Musculoskeletal Care. 2003;1:5–20.

    Article  PubMed  Google Scholar 

  13. Ryan S, Hassell AB, Lewis M, Farrell A. Impact of a rheumatology expert nurse on the wellbeing of patients attending a drug monitoring clinic. J Adv Nurs. 2006;53:277–86.

    Article  PubMed  Google Scholar 

  14. Tijhuis GJ, Zwinderman AH, Hazes JMW, Breedveld FC, Vliet Vlieland PMT. Two-year follow-up of a randomized controlled trial of a clinical nurse specialist intervention, inpatient, and day patient team care in rheumatoid arthritis. J Adv Nurs. 2003;41:34–43.

    Article  PubMed  Google 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

    Article  Google Scholar 

  16. Hill J. Patient satisfaction in a nurse-led rheumatology clinic. J Adv Nurs. 1997;25:347–54.

    Article  CAS  PubMed  Google 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.

    Article  Google Scholar 

  18. Arthur V, Clifford C. Rheumatology: a study of patient satisfaction with follow-up monitoring care. J Clin Nurs. 2004;13:325–31.

    Article  PubMed  Google Scholar 

  19. Bala SV, Samuelson K, Hagell P, Svensson B, Fridlund B, Hesselgard K. The experience of care at nurse-led rheumatology clinics. Musculoskeletal Care. 2012;10:202–11.

    Article  PubMed  Google Scholar 

  20. Arvidsson B, Jacobsson L, Petersson IF. Rheumatology care in Sweden—the role of the nurse. Musculoskeletal Care. 2003;1:81–3.

    Article  PubMed  Google Scholar 

  21. Muñoz-Fernández S, Aguilar MD, Rodríguez A, Almodóvar R, Cano-García L, Gracia LA, et al. Evaluation of the impact of nursing clinics in the rheumatology services. Rheumatol Int. 2016;36:1309–17.

    Article  PubMed  Google 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.

    Article  Google 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.

    Article  Google 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

  26. Chew LC, Lim TG, Loy KL, Kong MC, Chang WT, Tan SB, et al. A questionnaire survey of patient experience with the rheumatology monitoring clinic in Singapore. Int J Rheum Dis. 2012;15:390–8.

    Article  PubMed  Google Scholar 

  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

    Article  Google 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

  29. Larsson I, Fridlund B, Arvidsson B, Teleman A, Bergman S. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs. 2014;70:164–75.

    Article  PubMed  Google Scholar 

  30. Hall JJ, Katz SJ, Cor MK. Patient satisfaction with pharmacist-led collaborative follow-up care in an ambulatory rheumatology clinic. Musculoskeletal Care. 2016;15(3):186–95.

    Article  PubMed  Google Scholar 

  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/

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Muñoz Fernández S, Lázaro y De Mercado P, Alegre López J, Almodóvar González R, Alonso Ruiz A, Ballina García FJ, et al. Quality of care standards for nursing clinics in rheumatology. Reumatol Clin. 2013;9:206–15.

    Article  PubMed  Google Scholar 

  33. Brown SA, Grimes DE. A meta-analysis of nurse practitioners and nurse midwives in primary care. Nurs Res. 1995;44:332–9.

    Article  PubMed  Google 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

    Article  Google Scholar 

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Acknowledgements

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).

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Authors and Affiliations

  1. Faculty of Pharmacy and Pharmaceutical Sciences, 3-236 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave NW, Edmonton, AB, T6G 1C9, Canada

    Jill Hall

  2. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

    K. Julia Kaal, Junho Lee, Ross Duncan, Nicole Tsao & Mark Harrison

  3. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    K. Julia Kaal

  4. Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, BC, Canada

    Mark Harrison

  5. Arthritis Research Canada, Richmond, BC, Canada

    Mark Harrison

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Correspondence to Jill Hall.

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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.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Hall, J., Julia Kaal, K., Lee, J. et al. Patient Satisfaction and Costs of Multidisciplinary Models of Care in Rheumatology: a Review of the Recent Literature. Curr Rheumatol Rep 20, 19 (2018). https://doi.org/10.1007/s11926-018-0727-3

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