SHARED CARE BETWEEN HOSPITAL AND GENERAL-PRACTICE - AN AUDIT OF DISEASE-MODIFYING DRUG-MONITORING IN RHEUMATOID-ARTHRITIS

To assess the correspondence between ideal and actual monitoring for d isease-modifying anti-rheumatic drugs and the reasons for protocol fai lure, and the sharing of this task between primary and secondary care, we studied 249 patients with rheumatoid arthritis in a single distric t general hospital. Ideal monitoring protocols were derived from data sheets and from the rheumatological literature. Overall the ideal prot ocol was followed in 65% of cases: this ranged from 93% for methotrexa te to 26% for sodium aurothiromalate. Most of the monitoring was done in general practice (e.g. 67% of all blood tests) and, with some excep tions, general practitioners (GPs) were willing to perform this task. However, many GPs reported logistic differences with specimen transfer and expressed the need for more information and support. Poor communi cation between hospital, patient and GP was also found to be a cause o f protocol failure.