Patient-initiated hospital follow-up for rheumatoid arthritis

Objectives. To evaluate the clinical efficacy, cost and acceptability of a shared care system of patient- or general practitioner (GP)-initiated hospi tal review in rheumatoid arthritis (RA). Methods. A 2-yr randomized controlled trial of routine rheumatologist-initi ated review was compared with a shared care system. Shared care patients ha d no routine follow-up but patients or GPs initiated access to rapid review by the multidisciplinary team via a nurse-run helpline. Control patients h ad a rheumatologist-initiated medical review at intervals of 3-6 months. Cl inical and psychological status, resource use, and patient and CP satisfact ion and confidence were assessed. Three-monthly clinical data were assessed (blind) for safety monitoring, with failure set at a 20% increase in pain, disability or disease activity. Results. Two hundred and nine established RA patients participated, of whom 182 were evaluable. Safety-net failures were not different between groups. Shared care patients had less pain (24 months, 3.9 cm on a 10-cm visual an alogue scale vs 4.8 cm for controls; P < 0.05), a smaller increase in pain over 2 yr (+ 0.4 cm vs +1.6 cm for controls; P < 0.01), greater self-effica cy (6, 15, 18, 21 months, P < 0.05), used 33.5% less resources (pound 208 p er patient per year vs pound 313 for controls; P < 0.001) and were more con fident in the system (6, 9, 12, 18, 21, 24 months, P < 0.01 to P < 0.001). Conclusions. A patient-initiated system for hospital review over 2 yr offer s some clinical benefit compared with the traditional system, using fewer r esources and attracting greater patient confidence. Longer-term assessment of the system would be appropriate.